PMC6423671_01
Hospitalization, major medical interventions, and physician consultation
timeline for the boy in this report. Open circles represent specific
examinations, testing time points, or treatment interventions. Circles with
a dot in the center reflect short-duration hospitalization (days to a week).
The circles connected by a solid line represent an extended 11-week
hospitalization period (see case report). From October 2015 through April
2017, 24-hour psychosis remained unchanged despite the administration of
various neuropsychiatric drug combinations (see Figure 2). Beginning in January 2017,
antibiotics were administered, after which psychoses decreased in frequency
(yellow panel). By November 2017, no psychoses were reported (green
panel).. EEG, electroencephalography; EKG, electrocardiogram; MRI, magnetic resonance
imaging.
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Figure 1 depicts a timeline including major medical interventions, physician consultations, and hospitalizations, during which he was treated with multiple different psychotropic medications including antipsychotics, mood stabilizers, antidepressants, and benzodiazepines, often in combination with other pharmacologic agents (Figure 2).
Drug administration timeline for the boy in this report. Medications were
categorized by therapeutic indication. Solid lines between each medication
symbol reflect the duration of drug administration. The pink, yellow, and
green panels reflect 24-hour psychosis, isolated psychotic episodes, and
resolution of the psychosis, respectively.
10.1177_1179573519832014-fig2.jpg
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Figure 1 depicts a timeline including major medical interventions, physician consultations, and hospitalizations, during which he was treated with multiple different psychotropic medications including antipsychotics, mood stabilizers, antidepressants, and benzodiazepines, often in combination with other pharmacologic agents (Figure 2).
Photographs taken by the parents in February 2017, approximately 7 months
after cutaneous lesions were first observed. These cutaneous lesions
prompted the attending physician to suspect neurobartonellosis as the cause
of pediatric acute-onset neuropsychiatric syndrome in this patient. (A)
Cutaneous lesions on the left medial aspect of the thigh. (B) Cutaneous
lesions located in the medial aspect of the right axilla.
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Western blot IgG and IgM and viral titers were negative or equivocal. ANAs were not detected. When the evaluating physician observed the cutaneous "stretch mark-like" lesions on the boy's thighs and armpit (Figure 3), neurobartonellosis was proposed as a differential diagnostic consideration.