Infected von Meyenburg complex causing recurrent gram‑negative septicaemia: the critical diagnostic role of FDG‑PET/CT in a patient with hidradenitis suppurativa.

backgroundvon 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

conclusion¹⁸F-FDG PET/CT has proven value in investigation for fever of unknown origin. This case illustrates the value of this imaging not only in precise localization of the infectious source but also provides a suggestive metabolic pattern leading to the diagnosis of a rare congenital biliary condition, VMC, as a hidden source of infection otherwise masked by other comorbid infectious foci. Revealing the true source of loculated infection and its mechanism of spread leads to appropriate antibiotic therapy and treatment monitoring.