PEDIATRIC AUTOIMUNE NEUROPSYCHIATRIC DISORDERS ASSOCIATED WITH STREPTOCOCCAL INFECTIONS IN A 8 YEARS OLD BOY
Heriyanto Heriyanto,Dewi Sutriani Mahalini,IGN Made Suwarba
Medical School Of Udayana University Department of Child Health
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 of 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 : A 8 years 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 was showed a symptom of nystagmus with tic on face. Laboratory tests revealed ASTO 400 IU/ml, ECG and MRI were normal. A blood culture and throat swab were performed and showed no bacterial growth. We treated with ampicillin 100 mg/kg/day, oral haloperidol 0,5 mg BID, and intravenous methylprednisolone 2 mg/kg/day divided every eight hours. The involuntary movements decreased after treated for 7 days and has been achieved full recovery after 1 month.
Learning Points/Discussion : PANDAS is a combination of acute symptoms of tic or obsessive compulsive disorder (OCD) which follows streptococcus group A-beta hemoliticus infection, mostly affects male children onset at 4-9 years old. We report 8 years old male with involuntary movement and history of throat infection 1 month prior. ASTO 400 IU/ml as confirmed a diagnostic marker of a 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 treated. Multidiscipline investigation including pediatric neurology, radiology, microbiology, and with antibiotic therapy will support more better outcome without any disabilities.
Keywords: ASTO PANDAS Streptococcal infection
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
Mid City Hospital, 3-A Shadman II
Jail Road, Lahore ,Pakistan