Research

Ali A, Anugwom G O, Rehman U, et al. (May 12, 2021) Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever. Cureus 13(5): e14990. doi:10.7759/cureus.14990

Conclusions:  SC is a rare presentation of ARF. Without adequate treatment and supportive care, SC can cause severe functional impairment. ARF should be considered as a differential diagnosis in school-aged children presenting with choreiform movements. Chorea can be managed with antiepileptics and antipsychotics; however, evidence on IVIG use for chorea has also been reported. There is no international consensus on the standard choice of treatment; therefore, IVIG should be used in severe functional impairment when unresponsive to other therapies.

Elisabeth Fernell, Mikael Sundin, Anders Fasth, Lisa Dinkler, Martyna Galazka, Christopher Gillberg, Mats Johnson Acta Paediatr. DOI: 10.1111/apa.15805

Conclusion
No HLA allele association such as seen in children with narcolepsy after H1N1 immunisation could be confirmed in this group of children with PANS. However, more than half the group had a first‐degree relative with a diagnosed autoimmune disease.

Full Article

Piero Pavone, Manuela Ceccarelli, Silvia Marino, Daniela Caruso, Raffaele Falsaperla, Massimiliano Berretta, et al. Lancet Child Adolesc Health. 2021 . May 04, 2021 DOI:10.1016/S2352-4642(21)00135-8

“Post-infectious, autoimmune, and neuro-inflammatory events are the main mechanisms of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS).4 PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction.4 The estimated prevalence of OCD in childhood and adolescence is 0·25–4·00%, with those aged between 16–18 years (1%) having the highest prevalence.5, 6, 7 Here, we report on two unrelated children with PANS that started 2 weeks after a positive COVID-19 nasopharyngeal swab.”

• Two young adolescents Diagnosed with COVID-19 by a nasal swab
• PANS started 2 weeks after COVID-19 diagnosis
• Had acute new OCD, neuropsychiatric, and motor dysfunction symptoms
• SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS

Full Study

Alsheikh A M, Alsheikh M M (May 01, 2021) Obsessive-Compulsive Disorder With Rheumatological and Inflammatory Diseases: A Systematic Review. Cureus 13(5): e14791. doi:10.7759/cureus.14791

“Conclusions: Based on our findings, there is a strong correlation between OCD and different inflammatory as well as rheumatological biomarkers. Such correlations have been demonstrated in both adult and pediatric populations. Future studies should examine the safety and efficacy of anti-inflammatory medications, especially NSAIDs, for the management and control of OCD symptoms in both adults and children, particularly in the early stages of the disease.”

“Conclusion: There is increasing support for the role of infections in the genesis of AN in some patients. The data suggest that autoimmunity is playing a prominent role in the pathogenesis of microbial-induced AN, and that role has been elucidated in children and adolescents with PANS. This is the first documented case of Lyme borreliosis complicated by three co-infections triggering AN. This adds to the existing literature that infections can play a more prominent role in AN. The corollary is that physicians should become aware of this association in the evaluation of patients with AN, as it may provide a treatment option for this serious and sometimes fatal condition. The possibility that tick-borne infections could underlie the diagnosis of AN warrants further study.”

Chen, Renfen & Wei, Xiumei. (2021). The interference of laboratory tests by immunoglobulin infusion: Problems and solutions. Journal of Clinical Images and Medical Case Reports. 2. 10.52768/2766-7820/1047.

• IVIG infusion can interfere with a wide range of laboratory tests, leading to inaccurate results.
• The interference stems from the transfer of antibodies and biological agents from donors to patients during IVIG treatment.
• This interference affects tests in infectious disease serology, autoimmune serology, blood bank, haematology, and biochemistry.
• After receiving IVIG (intravenous immunoglobulin), testing for pathogens can be influenced by the antibodies present in the IVIG product. These antibodies may show decreased positivity over time, with the antibodies disappearing approximately 2-4 months after the IVIG treatment ceases. It’s crucial to consider the potential impact of IVIG on testing accuracy and consult with healthcare providers for guidance on the timing and methods of pathogen testing post-IVIG treatment.

El Tawil, Chady. (2022). Can PANDAS Swear? A Curious Case of Coprolalia in a 15 Year Old Girl presenting to the Emergency Department. 10.52544/2642-7184(X)XXXX.

Abstract: Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections, or PANDAS, is a diagnosis of children with an acute and fast onset of obsessions, compulsions or tics succeeding a Group A beta-hemolytic streptococcal infection. Coprolalia is a form of tics where the patient involuntarily says obscene and inappropriate words. We report a case of a 15-year old girl with a history of suspected PANDAS presenting to the emergency department with recurrent coprolalia without signs of a streptococcus infection. PANDAS and other neuropsychiatric syndromes can have different acute presentations. The ED physicians should be familiar with such disorders and presentations

Irina A. Vanzhula, Shruti S. Kinkel-Ram, Cheri A. Levinson. Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. Journal of Affective Disorders. Volume 283, 2021,p 302-309, DOI: 10.1016/j.jad.2021.01.083.

Highlights

• Difficulties controlling intrusive thoughts is a common symptom between eating disorders and OCD
• Perfectionism symptoms bridge eating disorders and OCD
• Restriction links to checking compulsions and rigidity
• Binge eating links to hoarding symptoms

Conclusions
The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.

Margo Thienemann, Michelle Park, Avis Chan, Jennifer Frankovich. Patients with abrupt early-onset OCD due to PANS tolerate lower doses of antidepressants and antipsychotics. Journal of Psychiatric Research, Vol 135, 2021, PP 270-278. DOI: 10.1016/j.jpsychires.2021.01.022.

• More than half of patients with PANS require psychotropic medication.
• Side effects requiring a therapy change are common.
• Drug doses at which side effects occur are usually less than recommended.
• Clinicians should start with lower doses of psychotropics in PANS patients.

“Antidepressants’ most common side effects were anxiety, agitation, aggression, and akathisia. Antipsychotics’ most common side effects were dystonia, aggression, self-injurious behavior, and movement abnormality. Side effects were common at doses lower than the suggested starting doses for these medications. Patients tolerated antidepressants and antipsychotics when doses were low.”