Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/4469 |
Resumo: | 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. |
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Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric CasesAttention Deficit Hyperactivity DisorderCentral Nervous SystemAuto-immune encephalitisCerebral Spinal FluidIntravenous ImmunoglobulinCross reactivityN-methyl-D-aspartateVaricella Zoster VirusChildHDE REUM PEDBackground: 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.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEDahiya, DMatos, CMLim, MMadureira, IDuarte, SByrne, SRossor, T2023-03-22T09:32:13Z20232023-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4469engBrain Behav Immun Health . 2023 Feb 11;28:10060210.1016/j.bbih.2023.100602info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-26T03:45:37Zoai:repositorio.chlc.min-saude.pt:10400.17/4469Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:46:11.614490Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
title |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
spellingShingle |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases Dahiya, D Attention Deficit Hyperactivity Disorder Central Nervous System Auto-immune encephalitis Cerebral Spinal Fluid Intravenous Immunoglobulin Cross reactivity N-methyl-D-aspartate Varicella Zoster Virus Child HDE REUM PED |
title_short |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
title_full |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
title_fullStr |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
title_full_unstemmed |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
title_sort |
Case Report: Varicella Associated Neuropsychiatric Syndrome (VANS) in Two Pediatric Cases |
author |
Dahiya, D |
author_facet |
Dahiya, D Matos, CM Lim, M Madureira, I Duarte, S Byrne, S Rossor, T |
author_role |
author |
author2 |
Matos, CM Lim, M Madureira, I Duarte, S Byrne, S Rossor, T |
author2_role |
author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Dahiya, D Matos, CM Lim, M Madureira, I Duarte, S Byrne, S Rossor, T |
dc.subject.por.fl_str_mv |
Attention Deficit Hyperactivity Disorder Central Nervous System Auto-immune encephalitis Cerebral Spinal Fluid Intravenous Immunoglobulin Cross reactivity N-methyl-D-aspartate Varicella Zoster Virus Child HDE REUM PED |
topic |
Attention Deficit Hyperactivity Disorder Central Nervous System Auto-immune encephalitis Cerebral Spinal Fluid Intravenous Immunoglobulin Cross reactivity N-methyl-D-aspartate Varicella Zoster Virus Child HDE REUM PED |
description |
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. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-03-22T09:32:13Z 2023 2023-01-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/4469 |
url |
http://hdl.handle.net/10400.17/4469 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Brain Behav Immun Health . 2023 Feb 11;28:100602 10.1016/j.bbih.2023.100602 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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