Eight cases of Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) with Inflammatory Bowel Disease (IBD): Immunologic Intersections

SUMMARY

“Eight cases of Pediatric Acute Onset Neuropsychiatric Syndrome (PANS) explores the intersection between Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Inflammatory Bowel Disease (IBD)”, presenting eight pediatric patients diagnosed with both conditions. All individuals in this case series were identified from Stanford Immune Behavioral Health Clinic, Cedars-Sinai Medical Center Pediatric Inflammatory Bowel Disease Program, and Dartmouth Neuroimmune Psychiatric Disorders (NIPD) Clinic.

PANS, the umbrella condition in which PANDAS falls under, was found to precede IBD in seven of the eight cases, often by many years. These patients also exhibited a high prevalence of immune-mediated comorbidities, including arthritis (63%) and eczema or asthma, along with a strikingly high incidence of first-degree relatives with psoriasis or psoriatic arthritis (71%). The study suggests shared immunological underpinnings among PANS, IBD, and other inflammatory disorders, potentially mediated by cytokine pathways such as IL-17 and TNF-α.

Notably, in 5 cases where a PANS diagnosis predated the IBD diagnosis, neuropsychiatric symptoms stabilized or improved following standard IBD therapy. This reinforces the importance of gastrointestinal and systemic immune evaluation in children presenting with PANS—particularly when accompanied by joint symptoms or a strong family history of autoimmune disease. Clinicians are encouraged to consider early immune-modulating therapy in such patients, as timely IBD management may improve both gastrointestinal and neuropsychiatric outcomes.

LINK TO PAPER: https://karger.com/dne/article-pdf/doi/10.1159/000543969/4334423/000543969.pdf