57. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections perceived as conversion disorder. A case study of a young woman

Abstract

There is growing evidence that obsessive–compulsive disorder and/or tics is associated with immune response following streptococcal infections (PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). This case report describes a woman with debut of headaches and anorexia at age 15. Two years later after throat infections, she developed acute severe motor and vocal tics and difficulties in walking but MR and EEG were normal. Symptoms persisted five months until 2 weeks penicillin V treatment was initiated due to elevated streptococcus titers in serum. Treatment resulted in several months of improvement, however after termination symptoms gradually reoccurred. In addition a range of psychiatric symptoms including auditory and visual hallucinations were diagnosed. At the age of 22 she occasionally used crutches and had a magnitude of motor symptoms, relapsing-remitting attacks of pain, confusion and regressive behaviors and thus was diagnosed with conversion disorder by a psychiatrist. However, laboratory check-up showed increased concentration of calcium-calmodulin dependent protein (CaM) kinase II activity in serum and CSF, supportive of a PANDAS diagnose. Flow cytometry of CSF showed increase of phosphatidylserine containing microparticles and HMGB-1, and scanning electron microscopy displayed spherical particles with a diameter of about 1 μm. Neuropsychological assessment revealed impaired visuospatial functioning and signs of cognitive deterioration. Current treatment with Amoxicillin with clavulanic acid has not resulted in improvement and intravenous immune globulin treatment (IVIG) is planned.