An adult man presented with several years of persistent fatigue, cognitive dysfunction, chronic pain, anxiety, depressive symptoms, and substantial functional impairment. He reported a prior diagnosis of Lyme disease and prolonged treatment, although documentation establishing the original diagnosis was unavailable. Subsequent infectious evaluation did not establish an active infectious etiology, and structural brain magnetic resonance imaging was reportedly unrevealing. Resting brain perfusion single-photon emission computed tomography demonstrated relatively decreased tracer activity involving bilateral temporal and occipital regions, the medial anterior prefrontal cortex, bilateral inferior orbitofrontal regions, and bilateral internal cerebellar regions, with relatively increased activity in the bilateral basal ganglia and thalami. These findings reflected qualitative interpretation of relative regional tracer distribution and were not used independently to establish diagnosis or etiology. Prior COVID-19 infection, sleep disturbance, chronic pain, psychiatric symptoms, stimulant exposure, caffeine use, and kratom use represented additional potential contributors. This case illustrates the descriptive role of brain perfusion SPECT in persistent cognitive and neuropsychiatric symptoms of uncertain and likely multifactorial origin.

brain perfusion SPECT, cognitive symptoms, neuropsychiatric symptoms, fatigue, Lyme disease, COVID-19