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Título

DIAGNOSTIC PROCESS OF PATIENT WITH PANDAS SYNDROME: CASE REPORT

Apresentação do caso

Male, 10 years old, referred to psychiatric care due to aggressiveness, stereotyped movements, progressively started 6 months ago, related to an outbreak of COVID-19 in the family - the patient did not show symptoms. At the consultation, the mother reported that the patient performed “twitching”, opisthotonic, oculogyric crises, and vocal intonations, in addition to obsessive movements to relieve thoughts that something bad was going to happen. No loss of consciousness during episodes. According to the patient, the crises were preceded by a feeling of restlessness, after which he felt relieved. He had auditory (command voices) and visual (animals) hallucinations, as well as a compulsion for symmetry, organization, and hygiene. Obstetric and pediatric history, he showed twin pregnancy, with preeclampsia, tobacco and alcohol use, without other complications. During management, initially with the hypothesis of obsessive-compulsive disorder, sertraline was started, which led to an improvement in symptoms, except for tics, which worsened. The medication dose was increased and risperidone was added. A new regimen provided an improvement in OCD, but the crises became frequent, with worsening of the command voices - suicide attempts - and lack of sphincter control. Imipramine was added to the regimen. Laboratory tests, neurological evaluation, cranial CT, and EEG were requested. All exams were within the normal range, except ASLO, which was slightly increased. In the neurological evaluation, the hypothesis of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus (PANDAS) emerged. The patient is still under follow-up using imipramine, sertraline, and risperidone for symptomatic control.

Discussão

The hypothesis of pediatric autoimmune neuropsychiatric disorder associated with group A streptococcus (PANDAS) is a disease characterized by tics, obsessive compulsive disorder and motor hyperactivity with abrupt and episodic choreiform movements that affects children between 3 and 12 years of age, and may be related to Group A Streptococcus infections. In view of the manifestations of the syndrome, the above case fits the diagnostic criteria and its course of improvement and abrupt relapses as well.

Comentários finais

Although it is a recently proposed and still little investigated pathology, PANDAS represents a possible model for the relationship of environmental factors in neuropsychiatric disorders.

Declaração de conflito de interesses de TODOS os autores

There is no conflict of interests.