Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections in an 8-Year-Old Boy

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a rare neuropsychiatric disorder in children. Obsessive-compulsive symptoms, tics and other neuropsychiatric disorders may occur after a group A beta-hemolytic streptococcal infection. Treatment is still unclear and debate still continues. The objective of this case report is to describe the clinical presentation and the management of PANDAS at Sanglah General Hospital. Case Presentation Summary: An 8-year-old boy complained of involuntary movement of his head and eyes since 5 days before admission. There was history of sore throat and fever for 3-4 days one month before admission. Physical examination showed symptom of nystagmus with tic on the face. Laboratory test revealed ASO 400 IU/ml, ECG and MRI were normal. Blood culture and throat swab were performed and showed no bacterial growth. We treated with ampicillin 100 mg/kg/day orally, haloperidol 0.5 mg BID orally, and intravenous methylprednisolone 2 mg/kg/day divided every eight hours. The involuntary movement decreased after treated for 7 days and has achieved full recovery after 1 month. Learning Point/Discussion: PANDAS is a combination of acute symptoms of tic or obsessive-compulsive disorder (OCD) which follows group A beta-hemolytic streptococcal infection, mostly affects male children at the onset of 4-9 years old. We report an 8-year-old male with involuntary movement and history of throat infection 1 month prior. ASO 400 IU/ml was confirmed as a diagnostic marker of the streptococcal infection. Pharmacological therapy for PANDAS involve eradication of streptococcal infection by using antibiotic (i. e penicillin) up to 5 years duration. Our case achieved full recovery after 1 month of therapy. Multidiscipline investigation including pediatric neurology, radiology, microbiology, and antibiotic therapy will support a more better outcome without any disabilities.