Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS): an indication for tonsillectomy

Int J Pediatr Otorhinolaryngol. 2011 Jun;75(6):872-3. doi: 10.1016/j.ijporl.2011.03.006. Epub 2011 Apr 3.


Children with obsessive compulsive disorder or tic disorders that are associated with streptococcal infections (Group A beta-hemolytic) in the oro-pharyngeal region are given the diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Tonsillectomy has been reported to resolve the neuro-psychiatric symptoms in these children. We have a case of a 9-year-old boy who was seen in our clinic with multiple recurrent streptococcal infections of the oro-pharyngeal cavity. He also exhibited neuro-psychiatric symptoms including agitation, hyperactivity, and tics. These symptoms followed his recurrent infections. Tonsillectomy was performed and in one year follow-up the patient did not have any recurrent streptococcal infections, and his neuro-psychiatric symptoms resolved completely. Guidelines for medical and surgical management of recurrent strep infections in the face of PANDAS are reviewed.

Publication types

  • Case Reports

MeSH terms

  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / etiology
  • Autoimmune Diseases / surgery*
  • Child
  • Humans
  • Male
  • Mental Disorders / microbiology*
  • Mental Disorders / therapy*
  • Obsessive-Compulsive Disorder
  • Recurrence
  • Streptococcal Infections / diagnosis*
  • Streptococcal Infections / etiology
  • Streptococcal Infections / surgery*
  • Streptococcus pyogenes*
  • Tonsillectomy*

Supplementary concepts

  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections