case_images: PMC6423671_01
case_images: 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.
case_images: 10.1177_1179573519832014-fig1.jpg
case_images: PMC6423671_01_10.1177_1179573519832014-fig1.jpg
case_images: fig1-1179573519832014
case_images: 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).
case_images: 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.
case_images: 10.1177_1179573519832014-fig2.jpg
case_images: PMC6423671_01_10.1177_1179573519832014-fig2.jpg
case_images: fig2-1179573519832014
case_images: 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).
case_images: 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.
case_images: 10.1177_1179573519832014-fig3.jpg
case_images: PMC6423671_01_10.1177_1179573519832014-fig3.jpg
case_images: fig3-1179573519832014
case_images: 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.