The question of PANDAS in adults

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are a well-defined cause of obsessive–compulsive disorder in children. However, they have not been described or fully investigated in adults newly diagnosed with obsessive–compulsive disorder. Methods: We describe an adult with onset of obsessive–compulsive disorder at 25 years of age after a severe antibiotic-responsive pharyngitis. He was evaluated with multiple psychiatric rating scales for obsessive–compulsive disorder and Tourette’s syndrome, as well as with serologic assays and radiologic studies. Results: In all respects except age our patient fulfilled established criteria for PANDAS. Assays for antibodies to group A β-hematolytic streptococci, serum D8,17 lymphocytes, antistriatal (neuronal) antibodies, and anticytoskeletal antibodies all supported the hypothesis that a poststreptococcal process was active. Magnetic resonance imaging was abnormal and is described. Conclusions: The findings suggest that this patient’s illness is similar to PANDAS in presentation and that poststreptococcal disease may result in adult-onset obsessive–compulsive disorder.