Case report: Varicella associated neuropsychiatric syndrome (VANS) in two pediatric cases.
Brain Behav Immun Health
; 28: 100602, 2023 Mar.
Article
en En
| MEDLINE
| ID: mdl-36860280
Background: Viral or bacterial infections can trigger auto-immune inflammatory reactions and conditions in children. Self-reactivity arises due to similarities in molecular structures between pathogenic microorganisms and regular body structures with consequent immune-cross reactions. Reactivation of latent Varicella Zoster Virus (VZV) infections can cause neurological sequalae, including cerebellitis, post-herpetic neuralgias, meningo/encephalitis, vasculopathy and myelopathy. We propose a syndrome caused by auto-immune reactivity triggered by molecular mimicry between VZV and the brain, culminating in a post-infectious psychiatric syndrome with childhood VZV infections. Case presentation: Two individuals, a 6-year-old male and 10-year-old female developed a neuro-psychiatric syndrome 3-6 weeks following a confirmed VZV infection with intrathecal oligoclonal bands. The 6-year-old male presented with a myasthenic syndrome, behavior deterioration and regression in school, he was poorly responsive to IVIG and risperidone, however had a pronounced response to steroid treatment. The 10-year-old female presented with marked insomnia, agitation, and behavioral regression as well as mild bradykinesia. A trial of neuroleptics and sedatives resulted in a mild unsustained reduction in psychomotor agitation and IVIG was also unsuccessful, however the patient was very responsive to steroid therapy. Conclusion: Psychiatric syndromes with evidence of intrathecal inflammation temporally related to VZV infections that are responsive to immune modulation have not been described before. Here we report two cases demonstrating neuro-psychiatric symptoms following VZV infection, with evidence of persistent CNS inflammation following the resolution of infection, and response to immune modulation.
ADHD - Attention Deficit Hyperactivity Disorder, CNS Central Nervous System; Auto-immune encephalitis; CSF Cerebral Spinal Fluid, IVIG Intravenous Immunoglobulin; Cross reactivity; Molecular mimicry; NG Nasogastric, NMDA - N-methyl-D-aspartate; Neuropsychiatric syndrome; PANDAS - Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus), PANS - Pediatric Acute onset Neuropsychiatric Syndrome; PET- FDG - positron emission tomography - fluorodeoxyglucose, VZV - Varicella Zoster Virus; Pediatric varicella zoster virus
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Tipo de estudio:
Risk_factors_studies
Idioma:
En
Revista:
Brain Behav Immun Health
Año:
2023
Tipo del documento:
Article
País de afiliación:
Irlanda
Pais de publicación:
Estados Unidos