Here we report a case of a 15-year-old female who had originally been diagnosed and treated unsuccessfully for
schizophrenia,
psychosis, severe anxiety, and depression. More in-depth history revealed an abrupt onset of her symptoms with remote acute
infections and many exhibited characteristics of
obsessive compulsive disorder with rituals. Work-up for underlying infectious, immunodeficiency, and autoimmune causes was unrevealing except for very high levels of anti-neuronal
antibodies which have been linked to
Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Treatment options were discussed with the family and it was decided to use a course of
plasmapheresis based on previous studies demonstrating efficacy and its safety profile. After course of
therapy, there was a dramatic resolution of her
psychosis, OCD traits, and anxiety. She was able to stop all of her
antipsychotic and anxiety medications and resume many of her previous normal daily activities. The effect of this treatment has been sustained to the present time. This case emphasizes the importance of exploring nontraditional treatments for severe, treatment-resistant
mental illness which requires a multidisciplinary approach. Further research is warranted in larger populations to investigate pathomechanisms and treatment of PANs/PANDAs.