Asymptomatic versus symptomatic patients: [18F]FDG-PET/CT patterns and evolutionary track of COVID-19 associated vasculitis

Abstract

Several patients experience unexplained persistent symptoms after recovering from severe acute respiratory syndrome-related coronavirus disease 2 (SARS-CoV-2) [the so-called long coronavirus disease (COVID)], with a negative impact on their quality of life. We report the evolutionary track of fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography ([18F]FDG-PET/CT) in two patients incidentally diagnosed with SARS-CoV-2 infection. In both cases, baseline PET/CT showed bilateral pneumonia associated with [18F]FDG vascular uptake. Vascular uptake was more evident in the baseline scan of the asymptomatic patient. Vice versa, it was more marked in the follow-up examinations of the patient who developed long COVID. These findings suggested that vascular inflammation and its duration are responsible for the clinical course of the disease and the development of long COVID.

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References

WHO Coronavirus Disease (COVID-19) Dashboard | WHO Coronavirus Disease (COVID-19) Dashboard [Internet]. Available from: https://covid19.who.int/ Accessed: 17 November 2020.

Editorial. Long COVID: let patients help define long-lasting COVID symptoms. Nature 2020;586:170. DOI: https://doi.org/10.1038/d41586-020-02796-2

Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network - United States, March-June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-8. DOI: https://doi.org/10.15585/mmwr.mm6930e1

Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603. DOI: https://doi.org/10.1001/jama.2020.12603

Garrigues E, Janvier P, Kherabi Y, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020 [Epub ahead of print]. DOI: https://doi.org/10.1016/j.jinf.2020.08.029

Sollini M, Ciccarelli M, Cecconi M, et al. Vasculitis changes in COVID-19 survivors with persistent symptoms: an [18F]FDG-PET/CT study. Eur J Nucl Med Mol Imaging 2020 [Epub ahead of print]. DOI: https://doi.org/10.1007/s00259-020-05084-3

Slart RHJA. FDG-PET/CT(A) imaging in large vessel vasculitis and polymyalgia rheumatica: joint procedural recommendation of the EANM, SNMMI, and the PET Interest Group (PIG), and endorsed by the ASNC. Eur J Nucl Med Mol Imaging 2018;45:1250-69. DOI: https://doi.org/10.1007/s00259-018-3973-8

Manson JJ, Crooks C, Naja M, et al. COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study. Lancet Rheumatol 2020 [Epub ahead of print]. DOI: https://doi.org/10.1016/S2665-9913(20)30275-7

Becker RC. COVID-19-associated vasculitis and vasculopathy. J Thromb Thrombolysis 2020;1-13. DOI: https://doi.org/10.1007/s11239-020-02230-4

Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis 2020;50:54-67. DOI: https://doi.org/10.1007/s11239-020-02134-3

Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J 2020;41:3038-44. DOI: https://doi.org/10.1093/eurheartj/ehaa623

Leisman DE, Ronner L, Pinotti R, et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med 2020 [Epub ahead of print]. DOI: https://doi.org/10.1016/S2213-2600(20)30404-5

Kermani TA, Warrington KJ, Amin S. Malignancy risk in vasculitis. Ther Adv Musculoskelet. Dis 2011; 3:55-63.

Manger B, Schett G. Rheumatic paraneoplastic syndromes - A clinical link between malignancy and autoimmunity. Clin Immunol 2018;186:67-70. DOI: https://doi.org/10.1016/j.clim.2017.07.021

Benharroch D, Osyntsov L. Infectious diseases are analogous with cancer. Hypothesis and implications. J Cancer 2012;3:117-21. DOI: https://doi.org/10.7150/jca.3977

Bakouny Z, Hawley JE, Choueiri TK, et al. COVID-19 and cancer: current challenges and perspectives. Cancer Cell 2020;38:629-46. DOI: https://doi.org/10.1016/j.ccell.2020.09.018

Grifoni E, Valoriani A, Cei F, et al. Interleukin-6 as prognosticator in patients with COVID-19. J Infect 2020;81:452-82. DOI: https://doi.org/10.1016/j.jinf.2020.06.008

Malik P, Patel U, Mehta D, et al. Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis. BMJ Evidence-Based Med 2020;bmjebm-2020-111536. DOI: https://doi.org/10.1136/bmjebm-2020-111536

Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020;120:876-8. DOI: https://doi.org/10.1055/s-0040-1709650

Bianconi V, Violi F, Fallarino F, et al. Is acetylsalicylic acid a safe and potentially useful choice for adult patients with COVID-19 ? Drugs 2020;1-14. DOI: https://doi.org/10.1007/s40265-020-01365-1

Frohman EM, Villemarette-Pittman NR, Cruz RA, et al. Part II. high-dose methotrexate with leucovorin rescue for severe COVID-19: An immune stabilization strategy for SARS-CoV-2 induced ‘PANIC’ attack. J Neurol Sci 2020;415:116935. DOI: https://doi.org/10.1016/j.jns.2020.116935

Byram K, Dua A, Husainat N, et al. American College of Rheumatology (ACR) Vasculitis Guideline; Updated 2019. Available from: https://www.rheumatology.org/Portals/0/Files/Vasculitis-Guideline-Project-Plan-Large-Medium-Vessel.pdf

Raymond E, Thieblemont C, Alran S, Faivre S. Impact of the COVID-19 outbreak on the management of patients with cancer. Target Oncol 2020 [Epub ahead of print]. DOI: https://doi.org/10.1007/s11523-020-00721-1

Published
2021-02-19
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Issue
Section
Case Reports
Keywords:
COVID-19, [18F]FDG-PET/CT, vasculitis, long COVID.
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How to Cite
Sollini, M., Gelardi, F., & Chiti, A. (2021). Asymptomatic <em>versus</em&gt; symptomatic patients: [18F]FDG-PET/CT patterns and evolutionary track of COVID-19 associated vasculitis. Beyond Rheumatology, 3(1). https://doi.org/10.4081/br.2021.45