An unusual white blood cell scan in a child with inflammatory bowel disease - A case report

Technetium-99m-labeled leukocyte (WBC) imaging is a valuable screening meth od for inflammatory bowel disease, especially in children, because of its h igh rate of sensitivity, low cost, and ease of preparation, A 14-year-old g irl is described who had juvenile arthritis and iritis complicated by infla mmatory bowel disease, She was examined for recurrent abdominal pain, A Tc- 99m stannous colloid WBC scan was performed, and tracer accumulation was se en in the small bowel in the region of the distal ileum on the initial 1-ho ur image. Delayed imaging at 3 hours also revealed tracer accumulation in t he cecum and ascending colon, which was not seen on the early image. A biop sy of the colon during endoscopy showed no evidence of active inflammation in the colon, The small bowel was not seen, Computed tomography revealed ch anges suggestive of inflammatory bowel disease in the distal ileum. The app earance on the WBC study was most likely a result of inflammatory bowel dis ease involving the distal ileum, with transit of luminal activity into the large bowel.