CXCR4-targeted molecular imaging after severe SARS-Cov-2 infection

Excerpt

We herein report on a 37-year-old male which suffered from severe pneumonia requiring mechanical ventilation due to acute infection with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2; COVID-19). Despite optimal anti-inflammatory treatment, the patient’s condition further deteriorated, leading to elevated inflammatory blood-based biomarkers, septic shock, and persistent temperature above 40 °C. Inflammatory-directed, whole-body positron emission tomography/computed tomography (PET/CT) targeting C-X-C motif chemokine receptor 4 (CXCR4) was scheduled to identify sites of inflammation, including the lung and distant sites of disease. In addition, previous studies investigating neutrophils also rendered CXCR4 as a potential target in severe cases [1]. After injection of CXCR4-targeting [⁶⁸Ga]Ga-PentixaFor, increased radiotracer accumulation was noted in the bone marrow and spleen on maximum intensity projection (a), indicating hematopoietic activation. Additional CXCR4-expressing, inflammatory foci were identified on transaxial PET/CT in the pharyngeal/palatine tonsils (b), along with right-dominant bilateral pneumonia (c), and in the distal right thigh (d, green arrows), which may be partially explained by intramuscular inflammation. On transaxial CT (e–g), only pulmonary involvement was recorded. …