Diagnostic process of patient with PANDAS syndrome: case report

Case presentation: Male, 10 years old, referred to psychiatric care due aggressiveness, stereotyped movements, progressively started 6 months ago, related an outbreak of COVID-19 in the family - patient did not show symptoms. At consultation, mother reported that performed “twitching,” opisthotonic, oculogyric crises, and vocal intonations, addition obsessive movements relieve thoughts something bad was going happen. No loss consciousness during episodes. According patient, crises were preceded by a feeling restlessness, after which he felt relieved. He had auditory (command voices) visual (animals) hallucinations, as well compulsion for symmetry, organization, hygiene. Obstetric pediatric history, showed twin pregnancy, with preeclampsia, tobacco alcohol use, without other complications. During management, initially hypothesis obsessive-compulsive disorder, sertraline started, led improvement symptoms, except tics, worsened. The medication dose increased risperidone added. A new regimen provided OCD, but became frequent, worsening command voices suicide attempts lack sphincter control. Imipramine added regimen. Laboratory tests, neurological evaluation, cranial CT, EEG requested. All exams within normal range, ASLO, slightly increased. In autoimmune neuropsychiatric disorder associated group streptococcus (PANDAS) emerged. is still under follow-up using imipramine, sertraline, symptomatic