Focal Hypermetabolism in the Pontine Region: a Coincidental Finding on [18F]FDG PET/CT that May Demo

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We report a case of a patient with complaints of progressive back pain while being suspected for bacterial arthritis of the left ankle. The [¹⁸F]FDG PET/CT confirmed an arthritis of the left tibiotalar joint without signs of spondylodiscitis. As coincidental finding, remarkably high [¹⁸F]FDG uptake in the pontine region was demonstrated while the patient was not having significant neurological symptoms. The patient appeared to be familiar with alcohol abuses and mild electrolyte disorders (incl. hyponatremia) when admitted to the hospital. Although MRI did not demonstrate the typical signal characteristics, one should always consider osmotic demyelination syndrome (ODS), formerly called central pontine myelinolysis (CPM), in patients with focal high [¹⁸F]FDG uptake in the pontine region and a recent history of overly rapid correction of hyponatremia.