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

Abstract

"Pediatric acute-onset neuropsychiatric syndrome", or PANS, is a rare syndrome characterized by an acute onset of obsessive-compulsive disorder (OCD), and/or severely restricted food intake accompanied by a variety of neuropsychiatric symptoms. To our knowledge, this is the first case report of twin adolescents with COVID-19-associated PANS. Dizygotic twin sisters in late teens, with abrupt and acute onset of severely restrictive food intake, weight loss, OCD, anxiety with intermittent auditory and visual hallucinations, depression, attention deficit, and sleep disturbances, simultaneously accompanied by milder neurologic symptoms such as hand tremor, tinnitus, dizziness, headache, and weakness of proximal muscles, were applied to child and adolescent psychiatry clinic. The only relevant agent underlying those neuropsychiatric and somatic complaints was COVID-19, and it was validated with laboratory testing, such as positive IgG titers of SARS-CoV-2 and negative biomarkers for other possible bacterial or viral agents. Generalized epileptic anomaly and a vermian/folial atrophy in the cerebellum were detected in further evaluations. Treatment options consisted of psychotropic agents, antibiotics, antiepileptic, and intravenous immunoglobulin transfusion finely treated the neuropsychiatric symptoms. Clinicians should consider SARS-CoV-2 as a potential agent, when a child presents with abrupt onset, dramatic neuropsychiatric symptoms also consisting of PANS, even in asymptomatic patients or with mild respiratory symptoms.

Keywords: CNS, Central nervous system; COVID-19; COVID-19, Highly contagious coronavirus disease 2019; GAS, Group A B-hemolytic streptococcus; IVIG, Intravenous immunoglobulin; IgG, Immunoglobulin G; OCD, Obsessive-compulsive disorder; PANDAS, Pediatric autoimmune neuropsychiatric syndrome associated with streptococcal infections; PANS; PANS, Pediatric acute-onset neuropsychiatric syndrome; Pediatric acute-onset neuropsychiatric syndrome; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2.

Fig. 1

Cranial MRI Illustration of Atrophic Vermian Folia in Cerebellum