A HoffMed Case Study: Guiding a Family Through the Complexity of PANDAS

Patient: “J.M.” (de-identified)
Age: 9-year-old male
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
Referred to: HoffMed Consulting for medication + supplement reconciliation and care optimization

Presenting Concern

Parents reported a sudden and dramatic behavioral change, described as:

• New-onset OCD-like behaviors

• Motor and vocal tics

• Severe separation anxiety

• Emotional outbursts and irritability

• New urinary frequency

• Sleep disruption

• Food restriction / sensory sensitivity

Parents stated: “It felt like a switch flipped overnight.”

Triggering Event

• 2 weeks prior: Febrile illness + sore throat at school

• Initial rapid strep: Negative

• Follow-up throat culture: Positive for Group A Streptococcus

• Behavioral symptoms began within days of infection

Clinical pattern consistent with PANDAS presentation

Relevant Medical History

• Recurrent tonsillitis (ages 6–8)

• Seasonal allergies, mild eczema

• No prior psychiatric diagnosis

• Family history of autoimmune disease

• Developmentally typical prior to onset

Medication & Supplement Load at Intake

(Common in PANDAS case: high complexity, overlapping agents)

Prescription / OTC

1. Amoxicillin: treatment for confirmed strep

2. Sertraline: started for anxiety/OCD

3. Guanfacine ER: tics / emotional regulation

4. Cetirizine: allergies

5. Melatonin: sleep support

6. Ibuprofen (PRN): parents noted temporary symptom relief

Supplements

1. Children’s multivitamin (with iron + zinc)

2. Vitamin D3 (duplicate source)

3. Omega-3 fish oil

4. Magnesium glycinate

5. Probiotic (high CFU)

6. N-acetylcysteine (NAC)

7. L-theanine

8. Elderberry gummies

9. “Immune blend” herbal tincture (multiple ingredients, unclear dosing)

Key Concern: Multiple immune-modulating products during an active neuroinflammatory process.

HoffMed Clinical Assessment

Key Findings:

• Presentation consistent with PANDAS-triggered neuroinflammation

• Polypharmacy and supplement stacking contributing to symptom variability

• Immune activation + neurochemical dysregulation

• Sleep disruption amplifying behavioral symptoms

• Nutrient insufficiencies (low ferritin, low vitamin D)

HoffMed Care Approach

Step 1: Medication & Supplement Reconciliation

• Removed overlapping immune stimulants

• Simplified supplement regimen

• Standardized timing to reduce nervous system stress

Step 2: Neuro-Immune Support Strategy

• Coordinated antibiotic timing

• Reduced inflammatory burden

• Focused on sleep + nervous system regulation

• Avoided over-supplementation during acute phase

Step 3: Family Education

• Explained PANDAS mechanism in simple terms

• Clarified difference between:

  1. Immune support vs immune stimulation

  2. Short-term symptom control vs long-term stabilization

• Set realistic recovery expectations

Step 4: Monitoring Plan

• Symptom tracking (tics, anxiety, sleep)

• Follow-up labs as needed

• Coordination with pediatrician / neurology

Early Outcomes

• Improved sleep within 1–2 weeks

• Decreased emotional volatility

• Reduction in tic frequency

• Parents reported improved daily functioning

• Clearer understanding of next steps

HoffMed Clinical Takeaway

PANDAS requires precision, not volume.

This case highlights:

• The danger of supplement stacking

• The importance of timing and simplification

• The need for coordinated care

• The value of education-driven, family-centered support

HoffMed focuses on clarity, safety, and individualized care- especially in complex neuroimmune cases.