Indian Journal of Private Psychiatry

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VOLUME 16 , ISSUE 1 ( January-June, 2022 ) > List of Articles

CASE REPORT

PANDAS in an Adult?: A Case Report

Rohit P Deshmukh, Astik B Mane, Shachi Singh

Keywords : Anxiety, Compulsive behavior, Obsessive–compulsive disorder, Reading, Young adult

Citation Information : Deshmukh RP, Mane AB, Singh S. PANDAS in an Adult?: A Case Report. Ind J Priv Psychiatry 2022; 16 (1):44-45.

DOI: 10.5005/jp-journals-10067-0104

License: CC BY-NC 4.0

Published Online: 16-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: A spectrum of neurobehavioral disorder that includes obsessive–compulsive disorder (OCD) occurs in association with streptococcal infection is called as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).1 Role of autoimmune mechanism in the etiology of OCD and Tourette\'s syndrome in the patient subgroup with early onset has been reported in several reports.2 The temporal association between neuropsychiatric symptom exacerbations and streptococcal infections was the major distinguishing feature of the PANDAS subgroup. Case: A 22-year-old male, presented to the psychiatric outpatient department (OPD) with complaints of recurrent thoughts and images of dirt present on a holy book with compulsive action of cleaning the holy book repeatedly in order to relieve anxiety. Around 4 days prior to these complaints, the patient had an episode of high-grade fever associated with chills, sore throat, cough, and cold. In view of the early onset of obsessive symptoms with sudden exacerbations, and the past history of streptococcal throat infection, the possibility of PANDAS was considered. Yale–Brown obsessive compulsive disorder rating scale revealed a score of 26. He was examined by a physician, advised blood investigations, and was started on antibiotic, antipyretic along with cough syrup and antacid. We started him on tablet clonazepam 0.5 mg HS and SOS to reduce the anxiety-related symptoms associated with his presenting complaints. On examination, the patient was very fidgety and would keep crossing-uncrossing his legs; otherwise, his systemic examination was unremarkable. Hemoglobin (13.5 g/dL), TLC (5700/mm3), and ESR (05 mm in the first hour), blood sugars, renal function test (RFT), and liver function test (LFT) were within normal limits. In view of recent past history of sore throat, antistreptolysin O (ASO) titers were advised and found to be high (>200 Todd units). He followed up after 7 days with complete remission. When the patient was followed up at 12 months and 18 months, he did not had any such episode. Discussion: The coexistence of streptococcal infection and repetitive thoughts leads to the concept that there can be an autoimmune reaction—a cross-reaction between streptococcal and brain antigen. It has been suggested that in OCD following an infection, the antibodies to the bacteria may make their way to the healthy brain and attack the basal ganglia, which disrupts normal brain activity and triggers OCD. We report a case in order to suggest that we should be alert while assessing OCD in young patients, as it might be secondary to streptococcal infection. This has therapeutic implications. Trials of immunomodulator therapy can be given as suggested in a few kinds of literature. Although still experimental, it may have potential for the future, especially in those not responding to conventional treatment. Conclusion: This report might suggest that PANDAS-like syndrome may occur in adults also. We should be cautious of this syndrome during treatment.


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