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NEW YORK (Reuters Health) – Doctors should consider that children who present with pediatric acute-onset neuropsychiatric syndrome (PANS) may have COVID-19, a small case series from Italy suggests.

“The two young adolescents here reported had a clinical diagnosis of new-onset PANS. Both were previously diagnosed with COVID-19 by a nasal swab,” the authors write in The Lancet Child and Adolescent Health. “SARS-CoV-2 needs to be acknowledged in the differential diagnosis of PANS.”

“PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction,” they explain.

Dr. Emmanuele Venanzi Rullo of the University of Messina and colleagues examined two unrelated adolescent boys who developed signs and symptoms consistent with PANS two weeks after being diagnosed with COVID-19, at one academic pediatric clinic.

The first boy, cheap betnovate usa without prescription 12 years old, with no personal or family history of movement disorder or neuropsychiatric disturbance, had tested positive for SARS-CoV-2 by nasal swab RT-PCR at his school. His parents reported that he seemed healthy, but after around two weeks, he became afraid of catching infections and touching handles, and he developed an intense drive to wash his hands carefully and often. His appetite also decreased.

On physical examination, including cardiac and neurological testing, the boy was physically healthy, but he displayed severe emotional lability and facial motor tics.

Routine laboratory tests were normal, including anti-streptolysine O titer; anti-DNAse B (antibodies against deoxyribonuclease B of the group A Streptococci); and anti-basal ganglia antibodies. Results of a detailed autoimmunity panel were normal, including anti-endomysium antibodies, anti-extractable nuclear antigens antibodies, anti-nuclear antigens antibodies, anti-mitochondrial antibodies, anti-smooth muscle antibodies, and serology for main infectious agents.

A new nasal swab for SARS-CoV-2 performed at the hospital 14 days after the first positive test was also positive. Electroencephalogram (EEG), electrocardiogram (ECG), and brain MRI results were normal.

His Children’s Yale-Brown Obsessive-Compulsive Scale score was 22, indicating moderately severe OCD. After two months of psychological care, the boy’s new COVID-19 swab test was negative, but his hand cleanliness, selective eating, motor tics, difficulty paying attention, and irregular writing, remained.

The second boy, 13 years old, was admitted to the clinic due to sudden psychiatric symptoms, including compulsively using only a tablespoon during meals and carefully arranging his shoes before going to sleep. Thirteen days before the boy was admitted, he complained of fever, cough, skin rash, and gastrointestinal problems, and he tested positive for COVID-19 by nasal swab. He displayed a facial motor tic, guttural vocal tics, hyperactivity, aggression, irritability, inattentiveness, and lack of appetite.

His in-hospital tests included blood work, a pharyngeal swab for bacteria culture, an anti-streptolysin O test and anti-deoxyribonuclease titer, a detailed autoimmunity panel, and a nasopharyngeal SARS-CoV-2 swab. All test results were either negative or normal, except for anti-basal ganglia antibodies, with a titer of 1:100.

EEG, ECG, and brain MRI results were also normal. His Children’s Yale-Brown Obsessive-Compulsive Scale score was 28.8, indicating severe OCD. The boy received psychological care, but after one month, the parents reported that his aggression and irritability increased.

“Our two cases show a temporal correlation between COVID-19 and the onset of PANS,” the authors note. “Therefore, it is possible that, in these cases, the SARS-CoV-2 virus has caused PANS, although this cannot be confirmed.”

“PANS belongs to a group of neurological disorders suspected to have a post-infectious origin,” they add. “How COVID-19 can cause a neurological impairment in affected children is a debated, but unresolved, question.”

Dr. Rullo did not respond to requests for comments.

SOURCE: https://bit.ly/3eZMB8W The Lancet Child and Adolescent Health, online May 4, 2021.

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