Discordant Uptake on Ga-67 and Tc-99m MDP Scintigraphy in a Patient with Multiple Myeloma: An Indication of Poor Prognosis

A 54-year-old woman with known stage IV multiple myeloma, proved by histologic analysis to be poorly differentiated plasma cell type 2 months earlier, was hospitalized for evaluation of persistent fever. Among other complications, stage IV sacral decubitus ulcers prompted Tc-99m MDP bone scintigraphy and subsequent Ga-67 scintigraphy for the evaluation of possible bone infection. Interestingly, bone infection was excluded, but there was more robust Ga-67 uptake compared with Tc-99m MDP. Previous reports in the literature suggest that this reflects fulminant disease with a poor prognosis.