Case report: PANDAS and persistent Lyme disease with neuropsychiatric symptoms

Complete resolution of symptoms following IVIg and antimicrobial treatment

In this newly published article, the authors describe the diagnosis, symptom progression and treatment of a 7-year-old female with serological evidence of Lyme disease who developed multiple neuropsychiatric symptoms six months after visiting a tick endemic region.¹ Prior to her diagnosis of Lyme disease, the patient had been treated for three distinct episodes of streptococcal pharyngitis and diagnosed with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections).

Over a three-week period, the patient developed multiple symptoms including obsessions, compulsions, aggressive behavior, dramatic declines in cognitive functioning, loss of math skills, the onset of dysgraphia and difficulty with social cues, fatigue, nighttime awakening, chills, joint and muscle pain, moodiness, separation anxiety and panic attacks.

Following several months of oral and IV antimicrobial treatment, the Cunningham Panel™ of tests was ordered to assess the presence of antineuronal antibodies against specific neuronal receptors. Based upon test results, “the decision was made to prescribe intravenous immunoglobulin (IVIg) in accordance with established treatment guidelines for the patient’s level of symptom severity.”

Cunningham Panel Before Treatment

Cunningham Panel After Treatment

“Over a span of 31 consecutive months of treatment with various antimicrobials and 3 courses of intravenous immunoglobulins (IVIg), she experienced complete remission and remains symptom free at the time of this publication.”

The authors conclude that “This patient’s case may be representative of numerous other cases of autoimmune neuropsychiatric illnesses where a patient may have concomitant infections and co-morbid diagnoses.”