Delayed Recognition of Autism Spectrum Disorder and Off-Label Lurasidone After Intolerance to Risperidone and Aripiprazole in a Latin American Child: A Case Report
- 1General Medicine, Universidad Católica de Honduras Nuestra Señora Reina de la Paz, San Pedro Sula, HND
- 2Pediatrics, Universidad Católica de Honduras Nuestra Señora Reina de la Paz, San Pedro Sula, HND
Abstract
Autism spectrum disorder (ASD) can be difficult to recognize when co-occurring psychiatric symptoms are more clinically prominent, which may delay diagnosis. We report the case of a nine-year-old Latin American boy whose ASD and obsessive-compulsive disorder (OCD) were not diagnosed until approximately 27 months after initial presentation with irritability, mood lability, anxiety, and, subsequently, hallucinatory experiences; these symptoms were initially managed as primary psychiatric conditions. During this interval, fluoxetine was discontinued due to symptom worsening, sertraline produced only partial benefit, and both Food and Drug Administration (FDA)-approved agents for irritability associated with autistic disorder were discontinued because of adverse effects: risperidone due to significant weight gain and aripiprazole due to nausea, vomiting, and dizziness. A detailed neurodevelopmental reassessment subsequently identified longstanding social communication difficulties, rigid routines, sensory sensitivities, and restricted interests, supporting diagnoses of ASD and OCD. Low-dose lurasidone (20 mg nightly) was initiated off-label alongside continued sertraline. Over the following year, the patient demonstrated sustained improvement in irritability, aggression, self-injurious behavior, anxiety, and sleep disturbance. Hallucinatory experiences resolved within approximately three months and did not recur, with no significant adverse effects observed. This case illustrates how more prominent psychiatric symptoms can mask ASD and describes the individualized use of off-label lurasidone after intolerance to approved agents. However, the temporal association with clinical improvement does not establish causality, and findings from a single case cannot demonstrate efficacy.
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BibTeX
@article{banegas2026delayed,
title = {{Delayed Recognition of Autism Spectrum Disorder and Off-Label Lurasidone After Intolerance to Risperidone and Aripiprazole in a Latin American Child: A Case Report}},
author = {Leiby Orellana Banegas and Raul Urbina and Yahaira Iveth I Flores Antúnez and Jessy A Mejia},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.117158},
url = {https://europepmc.org/article/PMC/PMC13718875},
note = {CC BY},
}
RIS
TY - JOUR
TI - Delayed Recognition of Autism Spectrum Disorder and Off-Label Lurasidone After Intolerance to Risperidone and Aripiprazole in a Latin American Child: A Case Report
AU - Leiby Orellana Banegas
AU - Raul Urbina
AU - Yahaira Iveth I Flores Antúnez
AU - Jessy A Mejia
PY - 2026
DA - 2026/09/29
JO - Cureus
DO - 10.7759/cureus.117158
UR - https://europepmc.org/article/PMC/PMC13718875
AB - Autism spectrum disorder (ASD) can be difficult to recognize when co-occurring psychiatric symptoms are more clinically prominent, which may delay diagnosis. We report the case of a nine-year-old Latin American boy whose ASD and obsessive-compulsive disorder (OCD) were not diagnosed until approximately 27 months after initial presentation with irritability, mood lability, anxiety, and, subsequently, hallucinatory experiences; these symptoms were initially managed as primary psychiatric conditions. During this interval, fluoxetine was discontinued due to symptom worsening, sertraline produced only partial benefit, and both Food and Drug Administration (FDA)-approved agents for irritability associated with autistic disorder were discontinued because of adverse effects: risperidone due to significant weight gain and aripiprazole due to nausea, vomiting, and dizziness. A detailed neurodevelopmental reassessment subsequently identified longstanding social communication difficulties, rigid routines, sensory sensitivities, and restricted interests, supporting diagnoses of ASD and OCD. Low-dose lurasidone (20 mg nightly) was initiated off-label alongside continued sertraline. Over the following year, the patient demonstrated sustained improvement in irritability, aggression, self-injurious behavior, anxiety, and sleep disturbance. Hallucinatory experiences resolved within approximately three months and did not recur, with no significant adverse effects observed. This case illustrates how more prominent psychiatric symptoms can mask ASD and describes the individualized use of off-label lurasidone after intolerance to approved agents. However, the temporal association with clinical improvement does not establish causality, and findings from a single case cannot demonstrate efficacy.
SN - 2168-8184
ER -