Altered Cerebral Glucose Metabolism Normalized in a Patient with a PANDAS-like Condition Following Treatment with Plasmapheresis

SUMMARY

This case report presents the first documented evidence of cerebral glucose metabolism changes in a PANDAS-like condition, using FDG-PET/CT imaging, and shows how plasmapheresis treatment normalized brain metabolism along with significant clinical improvement.

“Altered Cerebral Glucose Metabolism Normalized in a Patient with a Pediatric Autoimmune Neuropsychiatric Disorder After Streptococcal Infection (PANDAS)-like Condition Following Treatment with Plasmapheresis” follows an 18-year-old male who developed severe neuropsychiatric symptoms—sudden onset of involuntary movements, emotional instability, tics, sleep issues, OCD-like behaviors, and academic decline—three weeks following cardiac surgery (aortic valve replacement) and a recent streptococcal infection (high ASO titer: 805 kU/l). Previous treatments (antibiotics, IVIG, steroids) showed only minimal improvements.

However, a series of five plasmapheresis treatments led to substantial clinical recovery and, notably, complete normalization of previously abnormal brain metabolism as seen on FDG-PET/CT imaging after 4 months. The scans initially showed hypermetabolism in the basal ganglia and hypometabolism in the cortex—both of which fully resolved post-treatment. This is the first documented case to capture, in real-time, the reversible nature of cerebral metabolic dysfunction in a PANDAS-like condition (despite age slightly above typical pediatric range). And ASO titers returned to normal.
The report provides critical insight into the autoimmune basis of certain neuropsychiatric disorders and underscores the potential for advanced imaging and immunotherapy to transform outcomes in otherwise treatment-resistant cases.

LINK TO PAPER: https://doi.org/10.1186/s12883-018-1063-y