Background:With the advent of more sensitive culture and molecular diagnostic testing
modalities, Bartonella spp. infections have been documented
in blood and/or cerebrospinal fluid specimens from patients with diverse
neurological symptoms. Pediatric acute-onset neuropsychiatric syndrome
(PANS) is characterized by an unusually abrupt onset of cognitive,
behavioral, or neurological symptoms. Between October 2015 and January 2017,
a 14-year-old boy underwent evaluation by multiple specialists for
sudden-onset psychotic behavior (hallucinations, delusions, suicidal and
homicidal ideation).Methods:In March 2017, Bartonella spp. serology (indirect
fluorescent antibody assays) and polymerase chain reaction (PCR)
amplification, DNA sequencing, and Bartonella enrichment
blood culture were used on a research basis to assess
Bartonella spp. exposure and bloodstream infection,
respectively. PCR assays targeting other vector-borne infections were
performed to assess potential co-infections.Results:For 18 months, the boy remained psychotic despite 4 hospitalizations,
therapeutic trials involving multiple psychiatric medication combinations,
and immunosuppressive treatment for autoimmune encephalitis.
Neurobartonellosis was diagnosed after cutaneous lesions developed.
Subsequently, despite nearly 2 consecutive months of doxycycline
administration, Bartonella henselae DNA was PCR amplified
and sequenced from the patient’s blood, and from Bartonella
alphaproteobacteria growth medium enrichment blood cultures. B
henselae serology was negative. During treatment with
combination antimicrobial chemotherapy, he experienced a gradual progressive
decrease in neuropsychiatric symptoms, cessation of psychiatric drugs,
resolution of Bartonella-associated cutaneous lesions, and
a return to all pre-illness activities.Conclusions:This case report suggests that B henselae bloodstream
infection may contribute to progressive, recalcitrant neuropsychiatric
symptoms consistent with PANS in a subset of patients.