PANDAS
Case Study
A postpubertal girl presented with 3-month history of sudden-onset motor tics involving her limbs, torso, and face occurring several times daily. Initially, she presented to the emergency department with complaints of sudden-onset “seizures.” The imaging workup during her visit included electroencephalogram, magnetic resonance imaging, and computed tomography, which were all normal. The specialist’s conclusion was essentially a suspicion of malingering. The patient went to another physician, who, after workup, treated her for yeast with pharmacotherapy. After 1 month, her symptoms did not improve.
The patient and family presented to our clinic distraught and frustrated, as she was intending to drive soon, and this had been going on for approximately 3 months without an acceptable diagnosis or improvement. We performed an initial intake and were able to witness in the offi ce what had been considered a seizure, which was quickly identifi ed as an adventitious motor tic. Results of our ordered laboratory tests suggested possible PANDAS, with elevated ASO and antideoxyribonuclease titers that were 3 and 5 times the upper limits of reference ranges, respectively, and no known recent history of streptococcus infection.
She was treated that same day in our office with a single dose of penicillin G benzathine (1.2 million U) administered intramuscularly in the upper gluteal region. At the 1-week follow-up visit, she had not had any return of symptoms, which she previously had been plagued with several times a day. She returned to the office 4 weeks after the initial visit with a sudden recurrence of symptoms. Again, we administered a single dose of penicillin G benzathine intramuscularly, and this time we added oral curcumin supplementation (150 mg, tapering up to 600 mg). The penultimate time I saw her, she was given a final dose of penicillin G benzathine intramuscularly, she was continuing oral curcumin supplementation, and we modifi ed her yeast-free diet, as was indicated with gastrointestinal symptoms and fungal skin infection, to remove all possible yeast sources and fuel. We also added vitamin C daily (2000 mg) and a 5-day burst dose of oral prednisone (40 mg/d). Two months later at the most recent checkup, she had not had any return of symptoms.