Case Study – PANDAS and Lyme with IVIG as Treatment

This case study emphasizes the need to investigate for tick-borne infections in patients with PANDAS and there is increasing evidence for the use of IVIG in autoimmune neuropsychiatric illness.
  • Patients with chronic neuropsychiatric symptoms who do not respond adequately to traditional psychotropic medications may have an underlying immune-mediated condition triggered by one or more infections as evidenced in this case report.”
  • “Improvement in neuropsychiatric symptoms does not typically occur unless all co-infections are addressed and resolved,” according to the treating physician’s clinical experience.
  • “The presence of elevated antineuronal antibodies identified by the Cunningham Panel™ provided an aid in diagnosis and in directing immunomodulatory treatment.”
  • “The post-treatment resolution of these autoantibodies provided pathophysiological support for addressing both the infection(s) and the underlying immune system dysfunction which resulted in a positive medical outcome for this patient.”
  • “There is increasing evidence that IVIg and immunoglobulins are effective in treating autoimmune neuropsychiatric illness although the mechanism of action is uncertain.”

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Conclusion: The subject of this case report had a concomitant diagnosis of Lyme borreliosis and PANDAS, both of which are consistent with the neuropsychiatric symptoms she experienced. As evidenced by her recovery and resolution of symptoms, treating both the Lyme infection and streptococcal infection, as well as treating the underlying autoimmune etiology of her neuropsychiatric symptoms resulted in a successful outcome. This case report and treatment history reiterates the complex and challenging nature of infection-triggered autoimmune neuropsychiatric disorders such as PANDAS and PANS and that multiple concomitant infectious agents can frequently be identified in patients suffering from these complex neuropsychiatric disorders. The presence of elevated antineuronal antibodies identified by the Cunningham Panel™ provided an aid in the diagnosis and in directing immunomodulatory treatment. The post-treatment resolution of these autoantibodies provided pathophysiological support for addressing both the infection(s) and the underlying immune system dysfunction which resulted in a positive medical outcome for this patient.

Cross Amy, Bouboulis Denis, Shimasaki Craig, Jones Charles Ray. Case Report: PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution, and Recovery. Frontiers in Psychiatry. Vol 12, 2021. DOI:10.3389/fpsyt.2021.505941  

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