Dados do Trabalho

Título

Diagnosis of autoimmune cerebellitis detected by 18 F-FDG-PET/CT after Sars-Cov-2 infection

RESUMO

Case presentation: A 57-year-old man presented with Sars-Cov-2 infection in March 2020 with severe viral pneumonia, without the need for mechanical ventilation. He evolved after 2 weeks with gait ataxia, dysmetria, dysdiadochokinesia, vertigo with cerebellar features, cerebellar tremor and bilateral vertical nystagmus. Cranial magnetic resonance imaging was performed, which did not show any acute changes. Lumbar puncture was performed to collect cerebrospinal fluid that showed no changes. Brain PET-CT with 18F-FDG was performed, which showed anomalous hyperconcentration of the radioisotope in cerebellar tonsils and cerebellar vermis. Hypothesized post-COVID-19 autoimmune cerebellitis. Pulse therapy with methylprednisolone 1g/day was performed for 5 days, with considerable improvement in symptoms. He is discharged from the hospital with improvement of gait symptoms and improvement of nystagmus. After 15 days, improvement of dysdiadochokinesia and dysmetria, maintaining mild vertigo. After 2 months of pulse therapy, the patient was asymptomatic from a neurological point of view. Discussion: The diagnosis of encephalitis/cerebelitis using the PET-CT technique with 18-F-FDG infusion is effective in cases with normal CSF results described in the literature. Reports of autoimmune cerebellitis after COVID-19 infection are described in the literature with inconclusive results regarding the use of methylprednisolone or immunoglobulin. Final Comments: The report on the use of PET with 18-F-FDG for the diagnosis of autoimmune involvement of the central nervous system appears to be a promising alternative with increasing use. Considering the possible relationship between Sars-Cov-2 infection and autoimmune cerebellitis, it is necessary to publicize the method used to the scientific community in order to facilitate future prospective studies.

Palavras Chave

autoimmune cerebellitis; PET/CT; autoimmune encephalitis