Pediatric autoimmune neuropsychiatric disorders associated with Streptococcus in identical siblings

J Child Adolesc Psychopharmacol. 2011 Apr;21(2):177-82. doi: 10.1089/cap.2010.0085. Epub 2011 Apr 12.


Termed pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS), these cases of childhood-onset obsessive compulsive disorder and tic disorders resemble the presentation of Sydenham chorea, in that they have an acute onset following a group A beta-hemolytic streptococcal infection (group A Streptococcus), with accompanying neurological signs, and an episodic or sawtooth course. Familial associations of this subgroup of patients remain understudied. This report provides phenotypic descriptions of three youth with PANDAS as well as their genetically identical siblings (in two cases of twins and one case of triplets). These cases highlight the potential for environmental influences for discordant presentations in genetically identical siblings. Despite identical genetics, presentations showed marked variation across siblings (from a full PANDAS presentation to asymptomatic). Further research into environmentally driven influences such as postinfectious molecular mimicry and epigenetic factors that may influence the manifestation of these pediatric neuropsychiatric disorders will promote our understanding of their prevention and treatment.

Publication types

  • Case Reports

MeSH terms

  • Autoimmune Diseases / complications
  • Autoimmune Diseases / diagnosis
  • Autoimmune Diseases / epidemiology
  • Autoimmune Diseases / microbiology*
  • Child
  • Chorea / complications*
  • Chorea / immunology
  • Chorea / microbiology
  • Developmental Disabilities / complications
  • Developmental Disabilities / immunology*
  • Developmental Disabilities / microbiology
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / complications*
  • Obsessive-Compulsive Disorder / diagnosis
  • Obsessive-Compulsive Disorder / immunology
  • Siblings
  • Streptococcal Infections / complications*
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / immunology
  • Streptococcus
  • Streptococcus pyogenes
  • Tic Disorders / complications
  • Tic Disorders / diagnosis
  • Tic Disorders / immunology

Supplementary concepts

  • Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections