67Ga Scintigraphy for Assessment of Disease Severity and Treatment Response in Patients With Paracoccidioidomycosis

Abstract

Objective The evaluation of therapy response of patients with deep mycosis is a major challenge. The aim of this study was to assess the severity of disease at admission and evaluate treatment response of patients with paracoccidioidomycosis using Ga-67 scintigraphy. Subjects and Methods Seventy-three patients with fully active disease were enrolled. A scoring system based on clinicoradiological and serological evaluation and Ga-67 scan was devised. Pretherapy Ga-67 score of 73 patients was compared with clinicoradiological and serological scores. A subgroup of 23 patients was followed up during treatment, and the rates of improvement of their clinicoradiological, serological, and Ga-67 scores during treatment were compared at 3 time points (fully active phase, after clinical improvement, and clinically inactive disease). Results The correlations between scores before therapy were statistically significant. Ga-67 score correlated with clinical score (r = 0.47, P < 0.001). Serological score correlated with both Ga-67 and clinical scores (r = 0.32, P = 0.006, and r = 0.25, P = 0.034, respectively). Concerning evaluation of therapy response, clinicoradiological, serological, and Ga-67 scores decreased significantly after therapy (P < 0.001). Notably, Ga-67 score was the single one to become negative in most patients at the end of treatment (20 of 23 patients compared with 7 on clinicoradiological evaluation and 10 on serology, P = 0.003). Conclusions In patients with paracoccidioidomycosis, pretherapy Ga-67 scintigraphy correlates with disease severity. Serial Ga-67 scans seem to be helpful in evaluating the response to therapy.