Case Studies

How Mosaic Diagnostics’ Organic Acids Test (OAT) Uncovered the Source Preventing 6-year-old Erin Relax and Fall Asleep 

Publish Date

August 12, 2025

Metabolic Assessment
Descriptive image for OAT (Organic Acids Test) - MosaicDX
Organic Acids Test (OAT):

Organic acids are products of the body’s metabolic pathways.

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Patient Opportunity

Erin is a 6-year-old female who presented to the clinic with concerns of PANS/PANDAS. Her symptoms began about six months ago with outbursts of anger and aggression, hypersensitivity to sounds and textures, headaches, and difficulty falling asleep. Her mother reported that they previously lived in Florida, where their house tested positive for mold. After relocating to Georgia about a year ago, they discovered that their current home also had mold. It was remediated about three months ago, but Erin’s symptoms continued. 

Approach

Erin’s Organic Acids Test (OAT) revealed both mold colonization and clostridial overgrowth. The clostridial overgrowth was treated with a 27-day pulse regimen of Flagyl. Once completed, she began anti-fungal treatment for the mold colonization. Her ongoing care was guided by the remaining OAT markers. 

Erin was given supplements to support mitochondrial health, vitamin levels, detoxification pathways, and serotonin metabolism. Key supplements in her case included: 

  • Bovine colostrum 
  • NAC 
  • Acetyl-L-carnitine 
  • CoQ10 
  • Vitamin D3 + K2 
  • Allimax 
  • A probiotic containing Saccharomyces boulardii 

Results

Fourteen days into her Flagyl regimen, Erin’s family noticed a significant improvement. Her mood stabilized and her anger outbursts decreased markedly. She was able to wear socks for the first time in six months, as she had previously been unable to tolerate their texture. 

Eliminating gut colonization, supporting mitochondrial function, vitamin balance, detoxification, methylation, and neurotransmitter regulation are all critical components in treating PANS. Erin continued to make progress with focus and mood following anti-fungal treatment, and her hypersensitivity to textures and sounds did not return. 

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Learn more about Melissa Smith

*The patient name has been changed to protect their privacy.

This material is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Use of this information is at the reader’s discretion and risk.

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About the Author

Melissa Smith

I graduated with a BSN in nursing from Michigan State University. In my first few years out of school, I gained clinical experience in emergency room, intensive care, and primary care. I quickly discovered that pediatrics was my passion and, in 2014, graduated as a Pediatric Nurse Practitioner from Augusta University. Upon graduation, I went to work in private practice, treating children from birth to age 21.

However, 2016 marked a turning point in my career.

I was seeing a 13-year-old boy who I had seen a few times in the past. His father brought him in because his behavior had changed dramatically. The father was at a loss as to what to do to help his son and was at the point of committing him to a mental health facility, as he and his wife felt ill equipped to manage their son’s behavior at home.

I asked the father if he would hold off taking that step until I had the opportunity to run a few tests. He agreed. When the tests came back, the boy’s strep titers were extremely elevated — a classic sign of PANDAS. I treated him and, over the next two months, he got better and eventually made a full recovery.​

​Although the PANDAS diagnosis had been around since the ‘90s, this was my first experience treating it, and I was keen to learn more. So, I dove into the research. At the same time my mom was undergoing treatment for ovarian cancer and was working with a naturopathic oncologist who was incorporating many integrative therapies.​

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Through my own research and watching my mom walk her cancer journey, I began to see a very different picture of health and healing. It became clear to me that, while the allopathic model of medicine has its strengths, it also sometimes fails to see patients as more than the symptoms they present with. It fails to see that what we put in, on, and around our body can have a significant impact on our overall health. I came to understand that to truly heal patients we, as practitioners, must listen intently, consider the bigger picture, and dig deeper to find and investigate root causes. Thus began my interest and study of integrative medicine. Through one-on-one mentoring with highly credentialed functional medicine doctors, as well as additional education in functional lab work and nutritional therapy, I bring a specialized skill set to children struggling with autoimmune and other hard-to-treat disorders.

As a practitioner, I am also passionate about mental health. With the advent of the COVID-19 pandemic, I began seeing an explosion of depression and anxiety among my pediatric patients.  To better help these patients, I sought to expand my knowledge base through certification as a pediatric mental health specialist. It is my hope that I’ll be able to combine this knowledge with an integrative approach to help more children achieve optimal health in body, mind, and spirit.

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