The “Possessed” Child: Celiac Disease, PANS/PANDAS, and the Gut-Brain Connection

An 11-year-old with confirmed celiac disease developed hallucinations, severe anxiety, behavioral disturbances, and infection-associated symptom flares, prompting investigation into PANS/PANDAS, immune dysfunction, and the potential role of the gut microbiome.

Case Presentation

An 11-year-old male presented to a pediatric clinic with abdominal cramping. The cramping was described as sudden in onset, with episodes severe enough to cause the child to double over in pain throughout the day.

Approximately one year earlier, blood work had been performed, including an IgG food-intolerance panel. The panel reportedly demonstrated moderate reactivity to dairy, grains, vegetables, legumes, nuts, and meat, including eggs; mild reactivity to some fruits; and very low reactivity to seafood. Additional blood work demonstrated elevated reactivity to IgA, transglutaminase, and endothelial markers. Iron levels were low, with an elevated total iron-binding capacity (TIBC).

The child was treated with dietary modifications, slippery elm, iron, and omega-3 supplementation. He was also referred for endoscopy and colonoscopy to confirm suspected celiac disease. The child subsequently tested positive for celiac disease.

Initial Neuropsychiatric Presentation

Approximately two months after the diagnosis of celiac disease, the child’s parents contacted the provider requesting emergency assistance. They described the child as appearing “possessed.” The child was reportedly hallucinating, hearing voices, grinding his teeth, experiencing significant fear, and requiring hospitalization. Because the parents were concerned for their own safety, the provider directed them to seek emergency medical care. The child was transported to Phoenix Children’s Hospital, where he underwent further evaluation and imaging.

An MRI and a spinal tap were performed. According to the case history, these evaluations did not identify a definitive infectious, parasitic, or structural cause. Blood work reportedly did not identify a clear cause, and a rapid strep test was negative. The child was discharged with diazepam and without a definitive diagnosis. Within three days of discharge, the parents reported that the child continued to experience nightly episodes of intense fear and night terrors. He was reportedly unable to sleep because of his fear.

The child was hospitalized again following an episode of violence involving his mother. During this period, he repeatedly reported seeing another boy in the home who appeared to follow him. According to the parents, the child was considered to be lying and was subsequently released from the hospital.

The parents later identified gluten in toothpaste and other household products and concluded that the child appeared to react strongly to even small amounts of gluten exposure.

Dietary Management and Recurring Symptoms

Glycine and skullcap were administered, and additional blood work was obtained. Anti-DNase B and antistreptococcal antibody testing was reportedly negative at that time.

Probiotics were introduced, and the parents observed an apparent improvement in the child’s mood for approximately four hours following administration. Symptoms were reported to worsen consistently at approximately 7:00 p.m., when the child would reportedly hallucinate and see a young boy returning to the living room of the home.

Melatonin, 3 mg, was administered to assist with sleep. Diazepam was continued and reportedly well tolerated. The child remained on a strict diet and received vitamin supplementation because of the reported reactions he was experiencing following meals.

Phoenix Children’s Hospital’s gastroenterology department recommended Kate Farms pouches as a means of introducing foods that the child might tolerate. The child consumed approximately eight pouches per day because of the limited variety of foods available to him.

According to the case history, foods associated with moderate reactivity caused abdominal discomfort when administered. The child subsequently improved for approximately two months.

“They described the child as appearing ‘possessed.’”

Recurrence Following Upper Respiratory Infection

An upper respiratory infection subsequently developed. Following each reported infection, the child again began hearing voices and seeing the mysterious boy in the living room. Following this infection, the child’s progress appeared to plateau, and his stools changed to diarrhea. The probiotic dose was increased, after which the parents reported improvement in the child’s mood and cognition.

The parents subsequently increased the variety of foods provided through the pouches. Approximately two weeks later, hallucinations returned. According to the case history, no major change had been made other than the introduction of additional pouches.

The ingredients of the pouches were reviewed, and rosemary was identified as an ingredient in the beef pouches that had not previously been present in the other formulations. The parents and provider attributed the recurrence of symptoms to the rosemary and hypothesized that it had negatively affected the child’s developing gut microbiome.

The rosemary-containing pouches were removed from the child’s diet. Following their removal, the child reportedly improved and returned to his previous baseline. Immunoglobulin support was subsequently added, and further improvement was reported. Repeat blood work demonstrated anti-DNase B and antistreptococcal antibody levels above 1,600.

PANS/PANDAS-Oriented Treatment Protocol

A treatment protocol was subsequently developed that was described as resembling a classic PANS/PANDAS protocol. The protocol included one week of ibuprofen followed by two weeks of antibiotics from different antibiotic classes.

The child reportedly responded well to ibuprofen but continued to have significant difficulty sleeping. Skullcap was administered approximately one hour before bedtime along with 1 mg of melatonin. According to the case history, this combination was helpful for approximately one week.

After the first antibiotic was administered, the child’s symptoms reportedly became substantially more severe. The family described the child as failing to recognize his own family members, cursing, and hiding in a corner.

The family contacted emergency services, and the child was transferred to Phoenix Children’s Hospital. During this hospitalization, he underwent additional testing. Blood work reportedly did not reveal significant abnormalities other than elevated streptococcal antibodies.

The child was administered intravenous antibiotics and sedation and was kept under observation for three days. He was also given another antispasmodic medication. He was subsequently discharged to his family with instructions to follow up with a mental-health provider and his pediatrician.

Probiotic and Gut-Supportive Interventions

Because the family observed a recurrence of symptoms following the antibiotic treatment and believed that the child’s gastrointestinal microbiome had been disrupted, two probiotics were introduced: a spore-based probiotic and a probiotic containing Lactobacillus reuteri.

The child reportedly improved within several days of beginning the probiotics.

A gut-supportive protocol was then initiated. This included bone broth and a gut-support supplement administered for seven days. The child subsequently improved and became stable.

Approximately three weeks later, symptoms again began to emerge toward the end of the evening. The probiotic was changed in an effort to increase microbiome diversity. The new probiotic contained a greater diversity of organisms and included prebiotics. According to the case history, the child subsequently experienced a substantial improvement in mood.

Repeat blood work showed that antibody levels continued to decrease. No vitamin or mineral deficiencies were identified at that time. Food reintroduction was then initiated, beginning with small increases in dietary diversity.

Six-Month Follow-Up

Six months later, the parents reported no further appearance of the “ghost child” and no additional reported hallucinations, including following another upper respiratory infection.

The child’s stools also became more regular in their shape, color, and frequency.

Discussion

This case describes an 11-year-old male with confirmed celiac disease who subsequently experienced significant neuropsychiatric symptoms, including hallucinations, auditory experiences, severe fear, sleep disturbance, behavioral changes, and episodes of aggression.

The clinical course included multiple hospitalizations, neurological and infectious evaluations, dietary modification, nutritional supplementation, probiotics, immunoglobulin support, anti-inflammatory treatment, antibiotic therapy, and other supportive interventions.

The case history also describes an apparent relationship between changes in gastrointestinal symptoms and changes in the child’s mood, cognition, and neuropsychiatric symptoms. Improvements were reported following several interventions, including dietary changes, probiotic administration, removal of rosemary-containing food products, and subsequent changes in probiotic formulation.

The role of the gut microbiome is an important consideration in this case. The case history proposes that changes in the gastrointestinal environment may have been associated with changes in neuropsychiatric symptoms. However, the observations described in this single case do not establish a definitive causal relationship between the microbiome and the child’s hallucinations or other neuropsychiatric symptoms.

Similarly, the recurrence of symptoms following consumption of rosemary-containing pouches and subsequent improvement after their removal represents a temporal association reported in this case. The available information does not establish that rosemary caused disruption of the child’s microbiome or directly caused the recurrence of neuropsychiatric symptoms.

The case was further complicated by recurrent infections and elevated streptococcal antibody levels. According to the history, symptoms repeatedly appeared or worsened following infections, while subsequent interventions were associated with periods of improvement.

Conclusion

This case illustrates the complexity of managing a child with celiac disease who develops significant gastrointestinal and neuropsychiatric symptoms. The child’s clinical course involved recurrent symptoms, multiple hospital evaluations, dietary restrictions, nutritional challenges, infections, antibiotic treatment, and changes in probiotic therapy.

The case also highlights the importance of careful observation of changes in symptoms following dietary and therapeutic interventions. In this patient, changes in gastrointestinal function and reported changes in mood, cognition, and behavior occurred at multiple points during the clinical course.

The observations described in this case suggest an area worthy of further clinical investigation regarding the relationship between gastrointestinal health, the gut microbiome, immune responses, and neuropsychiatric symptoms. However, conclusions regarding causation or treatment effectiveness cannot be established from this single case alone.

The potential effects of dietary components and microbiome-directed interventions may warrant further investigation, particularly in patients with celiac disease and complex gastrointestinal or neuropsychiatric presentations. Any such interventions should be considered within the context of appropriate medical evaluation and ongoing pediatric care.

Author: NDNR-emmabelle-2026.