SARS-CoV-2 related Paediatric Acute-onset Neuropsychiatric Syndrome

Neurological and psychiatric manifestations have been reported in patients with COVID-19, including cerebrovascular events, encephalopathy, and Guillain-Barré syndrome. Among children and adolescents, a possible association between SARS-CoV-2 infection and paediatric acute-onset neuropsychiatric syndrome (PANS) has been suggested. PANS is characterized by the sudden onset of obsessive-compulsive disorder (OCD) or restricted food intake, along with neuropsychiatric symptoms and motor dysfunction. This study presents two paediatric cases of new-onset PANS occurring two weeks after a confirmed SARS-CoV-2 infection. The first patient, a 12-year-old boy, developed obsessive fears of contamination, compulsive handwashing, selective eating, emotional instability, and motor tics. The second patient, a 13-year-old boy, exhibited compulsive behaviors, motor and vocal tics, hyperactivity, irritability, and aggression. Both cases underwent extensive laboratory testing, brain imaging, and neurophysiological assessments, which yielded no alternative diagnoses. Despite psychological intervention, symptoms persisted after follow-up. The temporal association between SARS-CoV-2 infection and the onset of PANS in these cases suggests a potential link between COVID-19 and neuroinflammatory or autoimmune mechanisms triggering neuropsychiatric disorders in children. Further research is needed to elucidate the underlying pathophysiology and confirm causality.