INTERESTING IMAGE An Unusual Case of Intraabdominal Nocardia Abscess Detected by Tc-99m HMPAO-Labeled WBC Study Shabana Saeed, MBBS, MS,* J. Esteban Varela, MD,† Richard L. Nelson, MD,† and Michael J. Blend, PhD, DO* Abstract: Images of a 37-year-old woman with Crohn’s disease and recent onset of left lower quadrant pain are presented. Physical and radiologic findings were inconclusive. A Tc-99m-HMPAO-WBC study was ordered and found helpful in differentiating active Crohn’s disease of the bowel from a localized abscess. Surgical drainage revealed a well-encapsulated Nocardia abscess consistent with the WBC scan findings. The location of this type of infection is unusual for a patient with Crohn’s disease not on immunosup- pressive drugs. Key Words: Tc-99m WBC scan, Nocardia and Crohn’s disease, Nocardia intraabdominal abscess (Clin Nucl Med 2004;29: 270 –271) REFERENCES 1. Smego RA Jr, Gallis HA. The clinical spectrum of Nocardia brasiliensis infection in the United States. Rev Infect Dis. 1984;6:164. 2. Boiron P, Provost F, Chevrier G, et al. Review of nocardial infections in France 1987 to 1990. Eur J Clin Microbiol Infect Dis. 1992;11:709. 3. Simpson GL, Stinson EB, Egger MJ, et al. Nocardial infections in the immunocompromised host: a detailed study in a defined population. Rev Infect Dis. 1981;3:492. 4. Weldon MJ, Joseph AE, French A, et al. Comparison of 99m-technetium hexamethylpropylene-amine oxime labeled leucocyte with 111-indium tropolonate labeled granulocyte scanning and ultrasound in the diagnosis of intra-abdominal abscess. Gut. 1995;37:557. 5. Goldman M, Ambrose NS, Drolc Z, et al. Indium-111-labelled leuco- cytes in the diagnosis of abdominal abscess. Scand J Gastroenterol Suppl. 1994;203:11. 6. Lantto E. Investigation of suspected intra-abdominal sepsis: the contri- bution of nuclear medicine. Scand J Gastroenterol Suppl. 1994;203:11. 7. Kipper S. Radiolabeled leukocyte imaging of the abdomen. Nuclear Medicine Annual. 1995:81–127. 8. Arndt JW, Grootscholten MI, et al. Inflammatory bowel disease activity assessment using technetium-99m-HMPAO leukocytes. Dig Dis Sci. 1997;42:387. 9. Bauman JM, Osenbach R, Hartshorne M, et al. Positive indium-111 leukocyte scan in Nocardia brain abscess. J Nucl Med. 1986;27:60. 10. Orsolon P, Bagni B, Talmassons G, et al. Evaluation of patient with brain abscess caused by nocardia asteroides infection with Ga-67 and Tc-99m HMPAO leukocytes. Clin Nucl Med. 1997;22:407. Received for publication July 28, 2003; revision accepted September 15, 2003. From the *Section of Nuclear Medicine and the †Department of Surgery, University of Illinois Hospital, Chicago, IL. Reprints: Michael J. Blend, PhD, DO, Section of Nuclear Medicine, Uni- versity of Illinois Hospital, 1740 West Street, Chicago, IL 60612; E-mail: mjblend@uic.edu. Copyright © 2004 by Lippincott Williams & Wilkins ISSN: 0363-9762/04/2904-0270 DOI: 10.1097/01.rlu.0000118007.96291.21 Clinical Nuclear Medicine • Volume 29, Number 4, April 2004 270