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Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies

We report the case of a 72-y-old man with concomitant autoimmune encephalitis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient presented with subacute cerebellar syndrome and myoclonus several days after general infectious symptoms began. Methods: Clinical exam...

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Autores principales: Grimaldi, Stephan, Lagarde, Stanislas, Harlé, Jean-Robert, Boucraut, José, Guedj, Eric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Society of Nuclear Medicine 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8679632/
https://www.ncbi.nlm.nih.gov/pubmed/32709734
http://dx.doi.org/10.2967/jnumed.120.249292
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author Grimaldi, Stephan
Lagarde, Stanislas
Harlé, Jean-Robert
Boucraut, José
Guedj, Eric
author_facet Grimaldi, Stephan
Lagarde, Stanislas
Harlé, Jean-Robert
Boucraut, José
Guedj, Eric
author_sort Grimaldi, Stephan
collection PubMed
description We report the case of a 72-y-old man with concomitant autoimmune encephalitis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient presented with subacute cerebellar syndrome and myoclonus several days after general infectious symptoms began. Methods: Clinical examination, CT, PET, MRI, and autoantibody testing were performed. Results: The oropharyngeal swab test was positive for SARS-CoV-2. The brain MRI results were normal. Cerebrospinal fluid testing showed normal cell counts, a negative result on reverse-transcription polymerase chain reaction testing, and no oligoclonal banding. Brain (18)F-FDG PET showed diffuse cortical hypometabolism associated with putaminal and cerebellum hypermetabolism, compatible with encephalitis and especially cerebellitis. The immunologic study revealed high titers of IgG autoantibodies in serum and cerebrospinal fluid directed against the nuclei of Purkinje cells, striatal neurons, and hippocampal neurons. Whole-body (18)F-FDG PET and CT scans did not show neoplasia. Treatment with steroids allowed a rapid improvement in symptoms. Conclusion: This clinical case argues for a possible relationship between SARS-CoV-2 infection and autoimmune encephalitis and for the use of (18)F-FDG PET in such a context.
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spelling pubmed-86796322022-01-05 Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies Grimaldi, Stephan Lagarde, Stanislas Harlé, Jean-Robert Boucraut, José Guedj, Eric J Nucl Med COVID Commentaries We report the case of a 72-y-old man with concomitant autoimmune encephalitis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient presented with subacute cerebellar syndrome and myoclonus several days after general infectious symptoms began. Methods: Clinical examination, CT, PET, MRI, and autoantibody testing were performed. Results: The oropharyngeal swab test was positive for SARS-CoV-2. The brain MRI results were normal. Cerebrospinal fluid testing showed normal cell counts, a negative result on reverse-transcription polymerase chain reaction testing, and no oligoclonal banding. Brain (18)F-FDG PET showed diffuse cortical hypometabolism associated with putaminal and cerebellum hypermetabolism, compatible with encephalitis and especially cerebellitis. The immunologic study revealed high titers of IgG autoantibodies in serum and cerebrospinal fluid directed against the nuclei of Purkinje cells, striatal neurons, and hippocampal neurons. Whole-body (18)F-FDG PET and CT scans did not show neoplasia. Treatment with steroids allowed a rapid improvement in symptoms. Conclusion: This clinical case argues for a possible relationship between SARS-CoV-2 infection and autoimmune encephalitis and for the use of (18)F-FDG PET in such a context. Society of Nuclear Medicine 2020-12 /pmc/articles/PMC8679632/ /pubmed/32709734 http://dx.doi.org/10.2967/jnumed.120.249292 Text en © 2020 by the Society of Nuclear Medicine and Molecular Imaging. https://creativecommons.org/licenses/by/4.0/Immediate Open Access: Creative Commons Attribution 4.0 International License (CC BY) allows users to share and adapt with attribution, excluding materials credited to previous publications. License: https://creativecommons.org/licenses/by/4.0/. Details: http://jnm.snmjournals.org/site/misc/permission.xhtml.
spellingShingle COVID Commentaries
Grimaldi, Stephan
Lagarde, Stanislas
Harlé, Jean-Robert
Boucraut, José
Guedj, Eric
Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title_full Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title_fullStr Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title_full_unstemmed Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title_short Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies
title_sort autoimmune encephalitis concomitant with sars-cov-2 infection: insight from (18)f-fdg pet imaging and neuronal autoantibodies
topic COVID Commentaries
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8679632/
https://www.ncbi.nlm.nih.gov/pubmed/32709734
http://dx.doi.org/10.2967/jnumed.120.249292
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