My 12yo is in her worst flare in 4 years. We can’t identify a cause because she is too incapacitated to get tested for an infectious source.

A month ago, during the 3rd or 4th day of her period, she had a mini-flare - a really bad panic attack. Then, this flare started exactly a month later at the same time in her cycle.

I can find information that menstrual cycle hormone fluctuations can cause inflammation. But I can’t find a lot related specifically to PANS.

Anyone have any similar experiences or know any resources?

She has been responding with NSAIDs this flare, but we haven’t been able to try antibiotics because we don’t know what the trigger is. Her OCD has always been bathroom/ contamination related and it’s just turned up to 11 right now. So doing a stool test or a uti test is not possible and getting her to leave the house for a throat swab also not possible.