Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) in an adolescent undergoing treatment for B-cell acute lymphoblastic leukemia: A case report

Abstract

Introduction: Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) is a recent diagnostic category developed to encompass a broader range of clinical presentations than Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS). PANS includes symptoms such as the sudden onset of Obsessive-Compulsive Disorder (OCD) and other severe neuropsychiatric symptoms. Case Presentation: This case involves a 15-year-old adolescent with B-cell acute lymphoblastic leukemia who developed a complex neuropsychiatric syndrome following chemotherapy treatment. The patient presented with symptoms including poor appetite, elevated bilirubin and liver enzymes, along with obsessive-compulsive symptoms, anxiety, irritability, and psychotic episodes. After administering various treatments, including antibiotics, antivirals, and psychotropic medications, there was a significant improvement in both neuropsychiatric and hepatic symptoms. Discussion: This case presents a diagnostic challenge, as the symptoms could be consistent with several conditions, including limbic encephalitis and other neuropsychiatric disorders. Viral infections and autoimmune alterations were ruled out through specific studies, suggesting that the neuropsychiatric symptoms might be related to an autoimmune or inflammatory response in the context of chemotherapy treatment. Conclusions: This case highlights the importance of a multidisciplinary approach in diagnosing and managing PANS, emphasizing the need to rule out other disorders reaching a definitive diagnosis. The patient's positive evolution following targeted treatment supports the hypothesis of an underlying autoimmune or inflammatory etiology.