Pediatric Acute-onset Neuropsychiatric Syndrome and Mycoplasma Pneumoniae infection: A Case Report analysis with a metabolomics approach

Pediatric Acute-onset Neuropsychiatric Disorder (PANS) is a clinical condition characterized by sudden and dramatic obsessive-compulsive disorder with a suggested post-infectious immune-mediated etiology. This condition is accompanied by an extensive series of relatively serious neuropsychiatric symptoms. The diagnosis of PANS is made by "exclusion", as the individual PANS symptoms overlap with a multiplicity of psychiatric disorders with onset in childhood. Several researchers accumulated evidence to support the hypothesis that PANS was closely associated with a variety of infections. In the last decade, metabolomics played an essential role in improving the knowledge of complex biological systems and identifying potential new biomarkers, as indicators of pathological progressions, or pharmacologic responses to therapy. The metabolome is considered the most predictive phenotype, capable to catch epigenetic differences, reflecting more closely the clinical reality at any given moment and thus providing extremely dynamic data. In the present work, we review the most recent hypothesis and suggested mechanisms of this condition and describe the case of a 10 year -year-old girl with PANS, before and after clarithromycin treatment. The main results of this case report are discussed from a metabolomics point of view. The alteration of several metabolic pathways concerning the microbial activity highlights the possible role of the microbiome in the development of PANS. Furthermore, different metabolic perturbations at the level of the protein biosynthesis, energy and amino acid metabolisms were observed and discussed. Based on our observations, we believe that metabolomics is a promising technology to unravel the mysteries of PANS in the near future.