PANDAS and Lyme Disease in Children: Case Study

Updated March 2026

PANDAS and Lyme disease can produce similar neuropsychiatric symptoms in children. In this case report, a 7-year-old girl developed severe behavioral and cognitive changes after visiting a tick-endemic region. She was initially diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS), but further evaluation revealed Lyme disease and multiple coinfections. The case highlights how overlapping infections can complicate diagnosis when children present with sudden neuropsychiatric symptoms.

These challenges are part of the broader discussion of pediatric Lyme disease, where infection, immune responses, and neurologic symptoms may intersect.

Why PANDAS and Lyme Disease Can Be Confused

PANDAS and Lyme disease can produce overlapping neuropsychiatric symptoms in children. Both conditions may present with anxiety, obsessive behaviors, cognitive changes, irritability, sleep disturbances, and school difficulties. Because these symptoms may appear abruptly, distinguishing between infection-triggered autoimmune syndromes and tick-borne illness can be challenging.

When symptoms fail to improve with standard PANDAS treatment, clinicians may consider whether other infections, including Lyme disease or tick-borne coinfections, could be contributing to the clinical picture.

Some children diagnosed with PANDAS may have underlying Lyme disease or other infections contributing to neuropsychiatric symptoms.

Initial Presentation and PANDAS Diagnosis

The 7-year-old girl developed multiple physical and neuropsychiatric symptoms six months after traveling to a tick-endemic region. During this period, she was treated for three separate strep infections and was subsequently diagnosed with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).

PANDAS was considered based on classic symptoms and a history of strep, a positive ASO titer, and a slightly elevated DNase B titer. However, despite treatment, the patient’s symptoms continued to worsen.

The article by Cross and colleagues describing this case was published in Frontiers in Psychiatry.

Lyme Disease and Coinfections Discovered

Additional testing revealed she was also positive by CDC criteria for Lyme disease. The Lyme EIA and western blot IgM were positive with two of three bands. The western blot IgG was positive for three of ten bands at the IGeneX laboratory.

Her Bartonella henselae IgG was positive at Quest laboratories. Her IgG Mycoplasma and IgG Babesia duncani antibodies were positive at IGeneX. These findings suggested the presence of multiple infections beyond the initial PANDAS diagnosis.

Dramatic Cognitive and Behavioral Decline

Dr. Charles Ray Jones, co-author and treating physician, described the patient’s broad range of symptoms. On her first visit, the patient presented with crying, anxiety, headache, joint pain, decreased cognitive functioning, fatigue, nighttime awakening, and an extreme fear of sleeping alone.

The patient’s symptoms included obsessions, compulsions, ADHD-like behavior, decline in school work, separation anxiety, panic attacks, muscle and joint pain, mood lability, aggressive behavior, fatigue, headaches, difficulty sleeping, word-finding problems, and cognitive decline.

The young girl had previously been considered academically gifted. However, cognitive symptoms emerged rapidly. She reportedly told her mother, “Mom, something happened to my brain.”

The patient regressed from being a year ahead of her class in math to being unable to add beyond the number 10. She began having difficulty comprehending reading assignments. During a ride home with her mother, she asked, “Who are you? What’s your name again?” and “I know you are mommy, but what’s your name?”

Understanding PANDAS, PANS, and Lyme Disease in Children

PANDAS may be diagnosed when a streptococcal infection triggers sudden neurologic and psychiatric symptoms. PANS, or Pediatric Acute-Onset Neuropsychiatric Syndrome, is a broader category that includes cases triggered by infections other than streptococcus.

Researchers have proposed that infections beyond streptococcus—including tick-borne infections—may contribute to PANS-like presentations in some patients.

Psychiatrist Dr. Robert Bransfield has described a wide spectrum of neuropsychiatric symptoms reported in Lyme disease, including anxiety, mood disturbances, cognitive impairment, and behavioral changes.

Cunningham Panel and IVIG Treatment

According to the authors, the child was treated with multiple courses of oral and intravenous antibiotics including ceftriaxone, Omnicef, azithromycin, Tindamax, Bactrim, and Mepron.

Despite treatment, significant symptoms persisted and the Cunningham Panel was ordered to evaluate antineuronal antibodies.

The Cunningham Panel indicated elevated levels for Dopamine D1 receptor antibodies, Dopamine D2L receptor antibodies, and Tubulin antibodies.

Based on these findings, the physicians initiated intravenous immunoglobulin (IVIG). Over a span of 31 months of treatment with antimicrobial therapy and three courses of IVIG, the patient experienced complete remission and remained symptom-free at follow-up.

Complete Recovery Achieved

The patient ultimately recovered and returned to normal academic performance according to her mother.

The authors concluded that multiple infections may have contributed to the patient’s symptoms and that improvement occurred after addressing both infectious and immune-related factors.

Clinical Perspective

This case illustrates how complex neuropsychiatric presentations in children may involve overlapping conditions. While PANDAS focuses on streptococcal triggers, other infections—including Lyme disease—may contribute to similar symptoms in some patients.

When children fail to improve with standard PANDAS treatment, clinicians may consider a broader infectious evaluation, particularly when there is exposure to tick-endemic regions or unexplained systemic symptoms.

Frequently Asked Questions

What is PANDAS and how is it different from PANS?

PANDAS occurs when a streptococcal infection triggers neurologic and psychiatric symptoms. PANS is a broader category that includes cases triggered by infections other than strep.

Can a child have both PANDAS and Lyme disease?

Yes. Some case reports describe children diagnosed with both conditions. In these situations, clinicians may evaluate for additional infections when symptoms fail to improve.

What is the Cunningham Panel?

The Cunningham Panel measures antibodies directed against neuronal targets that may be associated with autoimmune neuropsychiatric syndromes.

What should parents do if symptoms do not improve?

When symptoms persist despite treatment, clinicians may consider reevaluating the diagnosis and exploring additional infectious or inflammatory causes.

Clinical Takeaway

When children diagnosed with PANDAS fail to improve with standard treatment, clinicians may consider a broader differential diagnosis. Tick-borne infections such as Lyme disease may contribute to neuropsychiatric symptoms in some cases.

This case highlights the importance of careful clinical evaluation when children develop sudden cognitive or behavioral changes.