PANDAS and Lyme Disease in Children: Case of a 7-Year-Old Girl

PANDAS and Lyme disease can produce overlapping neuropsychiatric symptoms in children. This case describes a 7-year-old girl who developed severe cognitive and behavioral changes six months after vacationing in a tick-endemic region of the United States.

I first read about this case reported by Cross and colleagues in the journal Frontiers in Psychiatry.

Severe Neuropsychiatric Symptoms

The patient developed a wide range of neurologic and psychiatric symptoms. Dr. Charles Ray Jones, the treating physician, explained that the child experienced:

Dramatic decline in cognitive functioning
Difficulty concentrating and focusing
Loss of previously learned math skills
Dysgraphia
Difficulty interpreting social cues
Slowed processing speed
Word-finding problems
Anxiety and panic attacks
Fatigue and nighttime awakening
Chills
Joint and muscle pain
Mood swings and separation anxiety

PANDAS and Lyme Disease Diagnosis

The child was diagnosed with both Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS) and Lyme disease.

The Cunningham Panel was positive for three of four antineuronal antibodies, findings considered consistent with PANDAS.

This case highlights how infections may trigger neuropsychiatric symptoms in children. In some cases, clinicians may consider evaluating for pediatric Lyme disease when symptoms develop after potential tick exposure.

Treatment and Recovery

The patient was treated with a combination of antimicrobial therapy and intravenous immunoglobulin (IVIG). Following treatment, the child recovered and her symptoms resolved.

The authors concluded that addressing both infectious and immune-mediated mechanisms may be important in complex cases involving overlapping conditions.

Reference

Cross A, Shimasaki C, Bouboulis D, Jones CR. Case Report of PANDAS and Persistent Lyme Disease With Neuropsychiatric Symptoms: Treatment, Resolution and Recovery. Frontiers in Psychiatry. 2021;12.

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Dr. Cameron is a Lyme disease expert and the author of Inside Lyme: An Expert’s Guide to the Science of Lyme Disease. He has been treating adolescents and adults with tick-borne diseases for more than 30 years.

Please remember that the advice given is general and not intended as specific medical advice for any individual patient. If you require specific medical advice, please consult a qualified healthcare professional.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention