Moleculera Labs Educational Series:

Neurologic and psychiatric symptoms associated with herpes virus infection

Case report: Varicella associated neuropsychiatric syndrome (VANS) in two pediatric cases
virus psychiatric

Reactivation of latent Varicella Zoster Virus (VZV) infections can cause neurological sequalae.

The authors of this case report propose adopting the term Varicella Associated Neuropsychiatric Syndrome (VANS) for syndromes caused by “autoimmune reactivity triggered by mimicry between [Varicella Zoster Virus] and the brain, culminating in a post-infectious psychiatric syndrome with childhood VZV infections.” 1

In their article, the authors describe a 6-year-old male and 10-year-old female who developed neurologic and psychiatric symptoms after a [Varicella Zoster Virus] infection, “with evidence of persistent CNS inflammation following the resolution of infection, and response to immune modulation.”

The patients met the criteria of autoimmune etiology of pediatric encephalitis with psychiatric and neurologic symptoms presenting 3 to 4 weeks after a confirmed VZV infection with intrathecal oligoclonal bands.

In both cases, the patients developed “marked behavioral change persisting for months and resulting in inability to attend school following infection with varicella zoster.”

The 6-year-old male presented with a myasthenic syndrome, behavior deterioration and regression in school. He did not respond to IVIG and risperidone, but had a pronounced response to steroid treatment.

The 10-year-old female presented with insomnia, agitation, and behavioral regression as well as mild bradykinesia. Three weeks prior to the onset of the behavioral disturbance she had chickenpox.

“We suspect an immune mediated pathology in these instances, whereby an acute VZV triggers auto-immunity through molecular mimicry between the virus and the brain.”

“A trial of neuroleptics and sedatives resulted in a mild unsustained reduction in psychomotor agitation and IVIG was also unsuccessful, however the patient was very responsive to steroid therapy.”

In both cases, patients had “unpaired oligoclonal bands in the CSF which persisted many months beyond VZV infection, and both patients responded to treatment with steroids.”

The authors conclude, “These cases demonstrate auto-immune cross-reactivity between [Varicella Zoster Virus] and native central nervous system structures that can manifest in neuro-psychiatric symptoms.”

How can the Cunningham Panel™ help you in identifying and treating patients with infection-induced autoimmune encephalopathies?

  1. Dahiya D, Matos CM, Lim M, Madureira I, Duarte S, Byrne S, Rossor T. Case report: Varicella associated neuropsychiatric syndrome (VANS) in two pediatric cases. Brain Behav Immun Health. 2023 Feb 11;28:100602. doi: 10.1016/j.bbih.2023.100602. PMID: 36860280; PMCID: PMC9969201.