Research

Raposo-Lima, C., Pereira, I.M., Marques, F. et al. Elevated levels of neutrophil gelatinase-associated lipocalin among OCD patients: an exploratory study. BMC Psychiatry 21, 272 (2021). DOI: 10.1186/s12888-021-03289-w

“Although PANDAS might be of relevance for only a minor proportion of OCD cases, this immune/inflammation hypothesis may be significant given the prevalence of OCS among patients with autoimmune diseases [9]…. In conclusion, we herein report differences in NGAL levels among OCD patients compared to healthy controls. We offer additional evidence to the immune dysregulation hypothesis of OCD by reporting elevated levels of NGAL among OCD patients versus healthy controls, with higher differences being found among women”

F Murgia, A Gagliana, MG Tanca, N Or-Geva, A Hendren, S Carucci, M Pintor, F Cera, F Cossu, S Sotgiu, L Atzori, A Zuddas. Metabolomic Characterization of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). Frontiers in Neuroscience. Vol 15. 2021. DOI: 10.3389/fnins.2021.645267  

• Found unique plasma metabolic profile in PANS patients that is significantly different from healthy children
• Suggests involvement of specific patterns of neurotransmission (tryptophan, glycine, histamine/histidine)
• Suggests a general state of neuroinflammation and oxidative stress (glutamine, 2-Hydroxybutyrate, and tryptophan-kynurenine pathway) in the disorder.
• Offers new insights into biological mechanisms underpinning the disorder and supports research of other potential biomarkers implicated in PANS.

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