Navigating the Challenges of PANDAS: A Case Study
HCN Medical Memo
The article discusses a case of an 18-year-old male patient with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), a condition that describes children who develop sudden onset or exacerbation of obsessive-compulsive disorder (OCD) or tic disorder (TD) following an infection with group A streptococcus (GAS). The patient’s condition was resistant to most treatments recommended in the literature, highlighting the complexity and challenges in managing PANDAS.
- PANDAS was first postulated in 1998.
- The diagnostic criteria consist of OCD or TD, prepubertal onset, episodic course, temporal association of GAS infection with symptoms, and neurologic abnormalities.
- Boys are affected twice as often as girls, starting around age 7 or 8 years.
- Management of PANDAS includes behavioral therapy or psychotropic drugs, immunomodulators in the presence of neuroinflammation or postinfectious autoimmunity, and antibiotics.
- The patient’s history includes acute onset of vocal/motor tics and ritualistic behaviors at age 14 years.
“He experienced multiple relapses and developed an obsession/fear of developing skin cancer, causing him to no longer shower, as well as anxiety and intrusive thoughts about being ill that was relieved by hitting his parents, which escalated to the point that they wore helmets.”
— Archadhaa Sivakanthan, MBBS; Joel Gedeon, MD; Sumaiyah Sadaf, MBBS; and Maria Bodic, MD
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