An Atypical Presentation of Pediatric Acute Neuropsychiatric Syndrome Responding to Plasmapheresis Treatment
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Here we report a case of a 15-year-old female who had originally been diagnosed and treated unsuccessfully for schizophrenia, psychosis, severe anxiety, and depression. More in-depth history revealed an abrupt onset of her symptoms with remote acute infections and many exhibited characteristics of obsessive compulsive disorder with rituals. Work-up for underlying infectious, immunodeficiency, and autoimmune causes was unrevealing except for very high levels of anti-neuronal antibodies which have been linked to Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Treatment options were discussed with the family and it was decided to use a course of plasmapheresis based on previous studies demonstrating efficacy and its safety profile. After course of therapy, there was a dramatic resolution of her psychosis, OCD traits, and anxiety. She was able to stop all of her antipsychotic and anxiety medications and resume many of her previous normal daily activities. The effect of this treatment has been sustained to the present time. This case emphasizes the importance of exploring nontraditional treatments for severe, treatment-resistant mental illness which requires a multidisciplinary approach. Further research is warranted in larger populations to investigate pathomechanisms and treatment of PANs/PANDAs.
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An atypical presentation of IAE was reported in a 15-year-old girl who manifested impulsivity, seizure-like spells, auditory hallucinations, and catatonic movements.
“An atypical presentation was recently reported involving a 15-year-old girl who also manifested impulsivity, “seizure-like” spells, auditory hallucinations, and catatonic movements.10”
From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [10]
The Case Presentation reports a 15-year-old girl with impulsivity, “seizure-like” spells, auditory hallucinations, and catatonic movements. The Clinical Course identifies her condition as pediatric acute-onset neuropsychiatric syndrome (PANS), not IAE, so the symptoms are supported but the paraphrase’s IAE identification is not. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAtypical cases of IAE have manifested in adults.
“Although classified as a rare condition, idiopathic autoimmune encephalitis (IAE) is estimated to affect up to 1 in 200 children, although atypical cases of IAE have also manifested in adults.”
From An updated review of pediatric autoimmune neuropsychiatric disorders associated with Streptococcus/pediatric acute-onset neuropsychiatric syndrome, also known as idiopathic autoimmune encephalitis: What the allergist should know (2023) · cites this paper as [10]
The Case Presentation describes a 15-year-old patient, and the Clinical Course discusses a suspected atypical autoimmune process in that patient. Neither those passages nor the Discussion reports atypical idiopathic autoimmune encephalitis in adults; searches for adult cases and atypical autoimmune encephalitis found no such passage. (LLM, conf=0.76)
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Cites
Characterization of the pediatric acute-onset neuropsychiatric syndrome phenotype
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Cited by
Sorted by citations
Hardin, H., Shao, W., & Bernstein, J. A. (2023) · Annals of Allergy, Asthma & Immunology · doi:10.1016/j.anai.2023.08.022 · Cited by 7 · see citing works
Self-citation
- Authors
- Barzman, D. H., Jackson, H., Singh, U., Griffey, M., Sorter, M., & Bernstein, J. A.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- University of Dayton (US)
- University of Cincinnati (US)
- Corresponding author
- Barzman, Drew H.
- Venue
- Case Reports in Psychiatry
- Publisher
- Wiley
- Published
- 2018-06-28
- Volume
- 2018
- Pages
- 1-5
- ISSN
- 2090-682X (ISSN-L)
- 2090-6838
- PMC
- PMC6046172
- OpenAlex
- W2811042247
- Cited by
- 7
- References
- 1
- Citations by year
- 2024: 1 · 2023: 2 · 2021: 2 · 2019: 2
- FWCI
- 0.68
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Case Reports in Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Neurology › Autoimmune Neurological Disorders and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- pediatric acute-onset neuropsychiatric syndrome, PANS, PANDAS, plasmapheresis, antineuronal antibodies, obsessive-compulsive disorder, psychosis, treatment-resistant mental illness, adolescents, autoimmune neuropsychiatric disorders
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