SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents

SUMMARY

“SARS-CoV-2/COVID-19 Associated Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS): A Case Report of Female Twin Adolescents” describes the first documented occurrence of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) potentially triggered by COVID-19 in dizygotic twin adolescents. PANS is marked by the abrupt onset of obsessive-compulsive behaviors or food restriction alongside other neuropsychiatric symptoms. While PANDAS, a subset of PANS, specifically involves a link to streptococcal infections, PANS can be triggered by various bacterial and viral infections.

The twins, previously healthy and without psychiatric history, developed an abrupt and severe onset of neuropsychiatric symptoms including obsessive-compulsive behaviors, severely restricted food intake, anxiety, depression, sleep disturbances, hallucinations, and neurological complaints such as tremors and dizziness. The more affected twin also had auditory/visual hallucinations, depression, and attention deficits. These symptoms appeared about two weeks after the girls were exposed to COVID-19 during a household quarantine, despite neither showing typical respiratory symptoms at the time.
Medical evaluations ruled out other possible causes, including gastrointestinal, endocrine, and other infections. Both twins tested negative for SARS-CoV-2 by PCR but were positive for SARS-CoV-2 IgG antibodies, indicating a past infection. No other infectious, metabolic, or autoimmune causes were identified. MRI and EEG of the more affected twin revealed mild cerebellar abnormalities and epileptic discharges. Psychometric tests confirmed moderate to severe depression, anxiety, and obsessive-compulsive symptoms.

Initial treatments with antibiotics and  psychotropic medications yielded limited improvement. However, following a subsequent course of intravenous immunoglobulin (IVIG) therapy, both patients experienced rapid and significant improvement in their psychiatric and physical symptoms, including normalization of eating patterns and reduced anxiety and hallucinations. This therapeutic response supported the suspected immune-mediated etiology of the symptoms and strengthened the hypothesis of COVID-19 as a potential trigger for PANS.

LINK TO PAPER: https://doi.org/10.1016/j.psycr.2022.100074