A 74-year-old man with type 2 diabetes presented with fever, urinary retention, and urinary difficulties. Initial abdominal Computed Tomography (CT) suggested acute pyelonephritis, but a low-density area in the prostate was overlooked. Following the confirmation of methicillin-resistant Staphylococcus aureus (MRSA) in blood and urine cultures, comprehensive screening for metastatic abscesses was necessitated. Diffusion-weighted whole-body imaging with background suppression (DWIBS) was utilized and clearly identified a prostatic abscess (PA), nephritis, urethritis, and subcutaneous cysts. These findings also raised suspicion of pyogenic vertebral osteomyelitis. Crucially, the PA, urethritis, subcutaneous cysts, and potentially the vertebral osteomyelitis were either overlooked or not detected by initial CT imaging. DWIBS allows for simultaneous whole-body screening and serves as a useful adjunctive tool for identifying minute abscesses, which may assist in detecting inflammatory foci that are sometimes overlooked by conventional imaging. Unlike CT, DWIBS avoids radiation and contrast agents, and is significantly more cost-effective than positron emission tomography-CT (PET-CT). DWIBS can thus serve as a useful, non-invasive tool for the early detection and exclusion of abscesses in other organs when metastatic abscess formation is suspected or cultures are positive for microorganisms causing metastatic abscesses.

We present the case of an 83-year-old woman with a long-standing history of rheumatoid arthritis (RA) who was found collapsed at home. The patient presented with cardiopulmonary arrest and could not be resuscitated. A postmortem examination was performed to determine the cause of death. Postmortem computed tomography (CT) ruled out intracranial hemorrhage but revealed diffuse bilateral pulmonary consolidations and signs of bronchial obstruction. The autopsy revealed severe pulmonary edema and marked right ventricular hypertrophy. Microscopic examination of the lungs demonstrated characteristic features of pulmonary veno-occlusive disease (PVOD), including widespread fibrous intimal thickening and occlusion of small pulmonary veins and venules. Notably, there was no evidence of RA-associated interstitial lung disease (ILD). The direct cause of death was identified as pulmonary edema secondary to PVOD. This case highlights that PVOD can occur in patients with RA as a distinct pathological entity, independent of ILD. This finding is significant as it contrasts with previous reports where PVOD was associated with ILD. Therefore, clinicians should consider PVOD in the differential diagnosis of RA patients who present with unexplained pulmonary hypertension or progressive dyspnea, even in the absence of interstitial lung disease.