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A case of Obsessive-compusive and related disorders against the background of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)

Background: The term Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections (PANDAS) was coined by Swedo et al. in 1998 to describe a subset of childhood obsessive-compulsive disorders (OCD) and tic disorders triggered by group-A beta-hemolytic Streptococcus pyogenes infection. Aims: To sensitise the medical community about the identification of the disease and reduce the morbidity associated with a late diagnosis. Case summary and results: We present a case of a 17 year old male presenting with repetive eye blinking, puckering movement of lips, skin picking behaviour, obsessive thoughts that his head is vibrating and compulsively placing his hand over his head to relieve the same, separation anxiety from mother, urinary incontinence and involuntary, jerky movements of upper limbs. The symptoms persisted over 5 years with relapsing and remitting course. Laboratory investigations including complete blood count, Anti-streptolysin -O(ASO) titres, throat culture sensitivity, C-Reactive Protein levels, Magnetic resonance Imaging(MRI) and Electro-encephalography(EEG) were done. His throat cultures showed Streptococcus pyogenes and raised ASO titres were found, with magnetic resonance imaging revealing no significant findings. Treatment with fluvoxamine, clomipramine and clonazepam along with behavioral therapy, have improved the severity of his condition. This report presents a case of Obsessive- compulsive and related disorders against the background of immunological reaction or PANDAS. Conclusion: In all school-age children presenting with obsessive compulsive and related disorder with other symptoms or not, a possible link to PANDAS should be evaluated and ruled out.