Sudden Onset Obsessive–Compulsive Symptoms Following Streptococcal Infection (PANDAS) in a Child: A Case Report

Abstract

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a condition characterized by the sudden onset of obsessive–compulsive symptoms and other neuropsychiatric manifestations following group A streptococcal infection. This case report describes a 9-year-old girl who presented with anxiety and symptoms of obsessive–compulsive disorder (OCD) that developed following a severe streptococcal infection. The patient experienced intrusive sexual thoughts involving fears that her mother might engage in sexual activity with her brother. Additional obsessions included beliefs that boys in her class were “dirty,” which led to avoidance behaviors. These intrusive thoughts caused significant distress and were accompanied by compulsive behaviors including blinking three times repeatedly, reciting religious verses, tapping three times on her knees, and blowing on herself to neutralize anxiety. The child also avoided touching classroom furniture and frequently texted her mother from school reporting distress related to her intrusive thoughts. According to parental reports, the patient had been functioning normally prior to the onset of symptoms approximately one year earlier when she developed a high fever and was hospitalized for three days due to a streptococcal infection. During the same period, a visiting cousin introduced sex education topics unfamiliar to the child, which appeared to influence the content of her obsessions. The patient demonstrated good insight into her symptoms and expressed a strong desire to overcome them. Following three months of psychological therapy with parental involvement, significant improvement in symptoms was observed. This case highlights the complex interaction between biological triggers and psychosocial influences in pediatric OCD associated with PANDAS.