PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection): a case report.

Case Report A 13-year-old boy was seen for acute onset of exuberant odd movements of the body and arms, associated with vocalizations, and worsening of his previous simple motor tics of the head and neck. He had a family history of simple motor tics (father and maternal uncle) and personal history of repeated throat infections during childhood documented by raised anti-streptolysin-O antibodies titers. During inpatient care he presented with obsessive-compulsive symptomatology (e.g., intrusive thoughts related to death and repeated saying of the word “no” that relieved them) and simple motor tics (eye blinking and neck jerking) that worsened in anxiety-producing situations. He also claimed that the odd movements described above relieved his death-related intrusive thoughts. A brain MRI showed no abnormality, anti-streptolysin-O antibodies titer was normal, and his total IQ score was 76. Previous Neuropsychiatric History At the age of 9, the patient had acutely developed intrusive thoughts of contamination and repeated hand washing associated with simple motor (eye blinking and neck jerking) and vocal (throat clearing) tics. A throat infection was documented at that time with raised anti-streptolysin-O antibodies titer. He was medicated with sertraline, 50 mg q.i.d., risperidone, 2 mg q.i.d., and penicillin, 2,000 units per month during 6 months. Two weeks later a significant symptomatic improvement had occurred. During the following waxing and waning course of his disease, he never experienced vocal tics again. Some of the simple motor tics and obsessive-compulsive symptom exacerbations occurred after a throat infection, were documented by raised antistreptolysin-O antibodies titers, and were treated with penicillin. A symptomatic remission occurred with 150 mg of fluvoxamine, 5 mg of haloperidol and 2 mg of biperiden. These doses were progressively titrated.