Tourette Syndrome Associated to Streptococcal Infections in 14 Years Old Male

Background: Tic is one clinical finding in pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Tourette syndrome is complex tic that consist of vocal and motor tic. Prevalence of Tourette approximately 5 per 10, 000 school-age children (0.05 %) and PANDAS was 1 % in children. Case Presentation Summary: A 14-year-old boy complained of involuntary movement with sudden jerky neck contraction and uncontrolled repeated blinking eyes for 5 years before admission and getting worse in few months. History of sore throat and fever about 4 months before tic occurred. Physical examination showed involuntary movement with motor tic on the neck and eyes and vocal tic with repeated coughing. Laboratory test revealed ASTO 400 IU/ml. Patient diagnosed with Tourette syndrome et causa PANDAS. Antibiotic prophylaxis was given with erythromycin 250 mg every 12 hours orally, prednisone 2 mg/kg/day for 7 days, haloperidol 0.02 mg/kg per day and clonazepam 1 mg every 12 hours. The purpose of therapy was to control tourette. After two weeks of treatment symptom was decreased. Learning Point/Discussion: We report a 14-year-old male with Tourette syndrome and ASTO 400 IU/ml was confirmed as a diagnostic marker of the streptococcal infection. Pharmacological therapy for PANDAS involved eradication of streptococcal infection by using antibiotic erythromycin up to 5 years duration, antiinflammation with prednisone, and treating involuntary movement haloperidol. Our case achieved recovery after 2 weeks of therapy.