The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.
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A 47-year-old woman, a diagnosed case of syndrome of inappropriate secretion of antidiuretic hormone, underwent 18F-FDG PET/CT to detect occult malignancy for suspected paraneoplastic etiology. Abnormal FDG uptake was noted in the right lower chest region, which was correlated on corresponding CT images to be colonic activity interposed between the liver and elevated diaphragm, also known as Chilaiditi sign. Even though rare, Chilaiditi sign should be considered as a differential diagnosis of hypermetabolic activity in the right lower chest region on 18F-FDG PET/CT scan that is done to look for occult tumor as shown in this case.
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