Acute-Onset Neuropsychiatric Syndrome May Present As Complic
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Neurological and psychiatric disorders in patients with a COVID-19 infection have been reported, such as cerebral ischaemic stroke, intracerebral haemorrhages, encephalopathy, and cerebral vasculitis and Gullian-Barre syndrome.

Pediatric acute-onset neuropsychiatric syndrome (PANS) belongs to a group of neurological disorders suspected to have a postinfectious origin. Autoimmune, and neuro-inflammatory events are the main mechanisms of PANS. Piero Pavone and his team reported two rare cases highlighting the association of pediatric acute-onset neuropsychiatric syndrome with COVID-19 infection.

~ CASE 1:

A 12 year old boy was referred with abrupt onset of psychiatric disturbaces. Prior to this he was tested positive for SARS-CoV2. Parents denied any past history of psychiatric or movement disturbances. After approximately 2 weeks, the boy presented a sudden onset of psychiatric signs, such as a fear of catching infections and touching handles with a severe drive to wash his hands very often and accurately.

Parents informed that he had facial motor tics, emotional lability and also showed reduced appetite. A general physical examination showed that he was physically healthy, including cardiac and neurological examinations. Basic laboratory tests were reported normal with a negative ASO titres and a negative anti-DNAase B antibodies.

He was tested positive for anti-basal ganglia antibodies with a titre of 1:200. Autoimmunity panel against certain specific antibodies was negative. At admission to hospital he was tested positive for SARS-CoV2, which is 14 days after first positive report. EEG and MRI brain were unremarkable for any focal lesion. Upon evaluation by the Children's Yale-Brown Obsessive Compulsive Scale score was 22.

Psychological intervention was started and child was under followup. After 2 months of follow-up, his distress for hand cleanliness persisted along with selective eating. Motor tics also persisted but were not constantly present. A swab test for COVID-19 was negative. The mother of the patient still had complaints about the boy's lack of attention and irregular writing.

~ CASE 2:

A 13-year old boy was admitted with sudden onset of psychiatric symptoms-such as a compulsive disorder characterised by using only a tablespoon during his meals and arranging the tip of his shoes in parallel before going to sleep. His past history was notable for positive SARS-CoV2 infection and was symptomatic. At the physical and psychological examination, he had a facial motor tic, guttural vocal tics, hyperactivity, aggressiveness, irritability and inattentiveness.

All laboratory tests had either negative or normal results except for anti-basal ganglia antibodies, which had a titre of 1:100. EEG and MRI brain were normal. He was scored 28 on the Children's Yale-Brown Obsessive Compulsive Scale. Psyhcological treatment was initiated and child was monitored frequently at OPD. At follow up after a month, parents reported that he continued to be aggressive and irritable with no clinical modification.

Therefore, it is possible that, in these cases, the SARS-CoV-2 virus has caused PANS, although this cannot be confirmed. Hence from the two young adolescents, a possible new-onset PANS has been reported suggesting a temporal correlation between SARS-CoV2 and PANS.

Authors conclude-"In the current ongoing pandemic, SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS."