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EV0217

PANDAS/PANS in boys with a previous diagnosis of autism spectrum disorder: a case series

PANDAS/PANS IN BOYS WITH PRE-EXISTING AUTISM SPECTRUM DISORDER: A CASE SERIES

When children with autism spectrum disorder develop sudden-onset obsessive-compulsive symptoms and tics, PANDAS/PANS should be considered rather than attributing every new behavioral change to autism.

The aim is to describe the clinical presentation, diagnostic assessment, and treatment of Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) in three boys previously diagnosed with autism spectrum disorder (ASD). The case series comprises three male patients aged 8, 13, and 14 years; all three had obsessive-compulsive symptoms and/or tics, two had infections and enuresis, and two exhibited regression. A multidisciplinary assessment was conducted with the involvement of a child and adolescent psychiatrist and a pediatric immunologist. It included a detailed developmental and psychiatric history, assessment of deviation from each individual's baseline functioning, evaluation of obsessive-compulsive symptoms and tics, medical and infectious disease histories, the temporal relationship between infection and symptom onset/exacerbation, and relevant laboratory investigations. The diagnosis of PANDAS was confirmed on the basis of streptococcal infection, sudden onset of obsessive-compulsive symptoms and tics, supportive laboratory findings, and exacerbations following viral infections. Treatment was individualized and multimodal: all patients received antimicrobial therapy, two underwent tonsillectomy and adenoidectomy, one received multiple courses of intravenous immunoglobulin (IVIG) and fluvoxamine, and one received aripiprazole for severe tics and behavioral outbursts. The authors emphasize that PANDAS/PANS should be considered when children with ASD experience sudden and marked neuropsychiatric deterioration, particularly the onset of new obsessive-compulsive symptoms and/or tics, and that attention to deviations from each individual's developmental baseline may be crucial to diagnosis. The clinical implication is that not every new behavioral change should be attributed to autism, and that a sudden deviation from baseline may reflect a clinically significant neuropsychiatric syndrome requiring further medical and psychiatric evaluation.

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