A Novel Case of PANS after Rickettsial Infection

摘要

PANS is a syndrome which consists of sudden development of obsessive compulsive disorder and/or severe eating restrictions, and associated characteristic cognitive, behavioral or neurological symptoms. PANS was first described in the 1990s by Susan Swedo's group.1 It was observed that OCD-like symptoms and tics tend to occur more commonly after a strong insult to the immune system, such as a viral or bacterial infection. Initially such cases were called PITANDS for Pediatric Infection Triggered Autoimmune Neuropsychiatric Disorders. It was noted that such cases of PITANDS followed infections with influenza, varicella (chickenpox), and streptococcal bacteria (strep throat and scarlet fever). In a recent study, cases were reported to occur in association with Lyme disease. Half of these case studies reported improvement after mental health treatment while other half reported improvement with antibiotic treatment. Authors of the study postulated that the symptoms of OCD after Lyme disease could be due to "direct physiological effects of the Lyme disease or associated immunologic response, a psychological response to illness, a functional somatic syndrome, or some combination of these."2 There has been a report of a PANS-like presentation in an 8 year old child after mycoplasma infections ("walking pneumonia"). Here we report a novel case of an 8-year-old with sudden behavior change after diagnosis and treatment for Rock Mountain Spotted Fever, a Rickettsial infection.