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

COVID-19 might be asymptomatic or might present with various signs and symptoms, such as a non-productive cough, fever, myalgia, fatigue, malaise, and gastrointestinal disturbances. Neurological and psychiatric disorders in patients with a COVID-19 infection have been reported, such as cerebral ischaemic stroke, intracerebral haemorrhages, encephalopathy, and cerebral vasculitis.1 The peripheral nervous system might be also affected. Ageusia, anosmia, myalgia, paraesthesia, and Guillain-Barré syndrome are the most reported disorders affecting the peripheral nervous system in patients with COVID-19.2, 3 Post-infectious, autoimmune, and neuro-inflammatory events are the main mechanisms of Paediatric Acute-onset Neuropsychiatric Syndrome (PANS).4 PANS presents with a sudden onset of obsessive-compulsive disorder (OCD) or a severely restricted food intake, and concurrent neuropsychiatric symptoms and motor dysfunction.4 The estimated prevalence of OCD in childhood and adolescence is 0·25–4·00%, with those aged between 16–18 years (1%) having the highest prevalence.5, 6, 7 Here, we report on two unrelated children with PANS that started 2 weeks after a positive COVID-19 nasopharyngeal swab.