The inflammatory autoimmune disorders they can be triggered by viral or bacterial infections in children. Today, we want to talk about a novel concept that has been observed in two pediatric patients: Varicella Neuropsychiatry Associated Syndrome (VANS).

This syndrome is hypothesized to is the result of autoimmune reactivity, caused by a molecular mimicry between the Varicella Zoster Virus (VZV) and the brain, leading to a post-infectious psychiatric syndrome in children with VZV infections.

In the two cases presented, children experienced neuropsychiatric symptoms after VZV infection, along with persistent central nervous system inflammation after resolution of the infection, and a modulated immune response. Both cases met the diagnostic criteria for autoimmune etiology of pediatric encephalitis.

The first case involves a 6-year-old boy who experienced neuropsychiatric symptoms, including anxiety, fear, emotional dysregulation, and visual hallucinations after a VZV infection. In it second case, a 10-year-old girl experienced behavioral disorders, characterized by restlessness, insomnia, uncontrollable crying, thought disturbances, and visual hallucinations, three weeks after contracting chickenpox.

Immunomodulatory treatments, including intravenous immunoglobulin (IVIG) and steroids, led to a marked improvement in symptoms, allowing the children to return to school.

However, patients did not return to their pre-illness state, experiencing ongoing problems with attention and mood fluctuations. The study suggests that VZV can precipitate an autoimmune response leading to neuropsychiatric syndromes in children, an observation that has not been reported before.

In the second segment of the study, the researchers point to other cases in which post-infectious psychiatric syndromes have been observed after VZV infection, such as anti-NMDA receptor encephalitis and progressive encephalomyelitis with rigidity and myoclonus (PERM). A common theme in these cases is the significant improvement of the syndromes when treated with antivirals and intravenous immunomodulatory steroids.

Here is the link to the article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9969201/