A 38 year female patient presented with progressive hypophonia, dysarthria and gait impairment due to parkinsonism for one month. She had no family history and she had MCTD diagnosed a few months before, for which she used corticotherapy. A MRI was made, showing bilateral hyperintensity in basal ganglia, with a  CSF slight pleocytosis. Infectious panel and laboratory testing for early onset movement disorders, like Wilson disease, was negative. High titers of anti-RNP were detected, so she was treated with intravenous methylprednisolone and cyclophosphamide. She was then treated with mensal immunoglobulin, with gradual clinical improvement. 

 Nonetheless, after a vaccine, she developed jaw closing dystonia,  arm torsional posture and truncal deviation. Her parkinsonism also worsened.  A new MRI showed T1 hyperintensities and SWI hypointensities in corona radiata, basal ganglia, substantia nigra, pons and cerebellum, suggesting accumulation of paramagnetic material, calcium and necrosis. HER CT showed calcification associated in all areas, except in globus pallidus and substantia nigra. Her whole exome testing was negative. Her FDG PET showed low uptake in bilateral frontal regions, basal ganglia, cerebellum and brainstem. A whole exome test was negative. We opted to start rituximab, with gradual gait and dystonia partial improvement.