Progressive Neuropsychiatric Symptoms Following Recurrent COVID-19 Infections in a Previously Healthy Adolescent

Table 2

Laboratory and imaging evaluation.

Differential diagnosis	Test(s)	Treatment day	Result
Autoimmune encephalitis	CSF^c cell count with differential	322	Red blood cells 133 cells/μL (traumatic tap)
	Mayo autoimmune encephalitis panel ENC2	323	Negative
	MRI^d	319	Noted below^e
		421	Stable from previous
Bartonella henselae	B. henselae antibodies	324	Negative
Hepatic encephalopathy	Ammonia NH3	439	Negative
	Hepatitis panel		Negative
	Amino acids		Negative
Hyperlipidemia	Lipid panel	421	TG^i 169 mg/dL (high); HDL^j 36 mg/dL (low); LDL^k 71 mg/dL (normal)
Hyperthyroidism	Thyroid-stimulating hormone	50	1.35 μIU/mL
		319	2.29 μIU/mL (normal)
	Thyroid peroxidase autoabs^h	439	Negative
	Thyroglobulin autoabs		Negative
Lyme disease	Lyme disease antibodies	324	Negative
Marijuana use disorder	Urine drug screen	319	Positive cannabinoids
	Marijuana metabolites qnt		19 ng/mL; (>5 ng/mL limit)
Meningitis	CSF meningoencephalitis PCR^g	322	Negative
Multiple sclerosis	CSF oligoclonal bands	322	Negative
PANDAS^b	Beta strep group A culture	316	Negative
SARS-CoV-2 infection sequelae	SARS-CoV-2 antibodies	439	Positive
	SARS-CoV-2 IgG II qnt^a		1,537.8 AU/mL
	T and B-cell enumeration panel		CD3, CD4 (low); CD8,19,16,56 (normal)
	SARS-CoV-2 antigen	298	Positive
Substance use disorder/intoxication	Urine drug screen	177	Negative
		421	Negative
		479	Negative
Systemic lupus erythematosus	ANA IFA^f with reflex to titer	386	Negative
Wilson’s disease	Ceruloplasmin	421	Negative

^aSARS-CoV-2 IgG II quantitative antibody assay. ^bPediatric autoimmune neuropsychiatric disorder associated with group A streptococci. ^cCerebrospinal fluid. ^dMagnetic resonance imaging. ^e“Multiple small foci of T2/FLAIR hyperintense signal in the left greater than right frontal subcortical white matter, left frontal corona radiata, and left frontal periventricular white matter. Overall, these lesions, especially in the subcortical white matter, are of uncertain clinical significance and may reflect gliosis from a variety of nonspecific remote insults. Appearance of the lesions in the left frontal periventricular white matter, however, also raises the possibility of nodular periventricular gray matter heterotopia”. ^fAntinuclear antibodies using immunofluorescence assay. ^gCerebrospinal fluid meningoencephalitis polymerase chain reaction. ^hThyroid peroxidase autoantibodies. ⁱTriglycerides. ^jHigh-density lipoprotein. ^kLow-density lipoprotein.