Infected von Meyenburg complex causing recurrent gram‑negative septicaemia: the critical diagnostic role of FDG‑PET/CT in a patient with hidradenitis suppurativa
Abstract
Background: von Meyenburg complex (VMC) is a rare ductal plate malformation, typically presenting as asymptomatic benign intrahepatic biliary microhamartomas. However, when secondarily infected, VMC can become the source of cryptic recurrent septicaemia, posing a substantial diagnostic challenge, particularly in patients with a known history of chronic source of comorbid infection.
Case presentation: A 73-year-old man with long-standing hidradenitis suppurativa presented with over ten episodes of recurrent gram-negative septicaemia. Extensive conventional imaging, including a 67Gallium scintigraphy in another hospital, failed to identify an infectious source. Due to persistent diagnostic uncertainty, ¹⁸F-FDG PET/CT was performed. The scan revealed an enlarged liver with heterogeneously increased ¹⁸F-FDG uptake exhibiting an "inverted pyramidal" metabolic configuration: a wide base of activity along the subcapsular dome of superior hepatic segments converged centripetally towards the porta hepatis, thereby casting a tree-like three-dimensional anatomy of the biliary radicles. CT findings were non-specific, showing vaguely scattered mixed densities, greatly outnumbered by the hypermetabolic foci. Constellation of these findings suggests a non-dilated ductal infectious process, leading to the presumptive diagnosis of infected VMC with micro-abscesses. Subsequent MRI/MRCP confirmed numerous tiny T2‑weighted bright signals of varying sizes and intensities in agreement with the…
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