Infection-triggered anorexia nervosa in children: clinical description of four cases.
BACKGROUND
Anorexia nervosa (AN) is a serious illness with no definitive treatment. Clinical and research evidence led to the hypothesis that some children with AN may have a pediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), similar in pathogenesis to other hypothesized PANDAS disorders.


METHODS
Four youngsters (ages, 11-15 years) with PANDAS AN were treated with an open trial of antibiotics, in addition to conventional treatment. They were evaluated for eating disorder and obsessive-compulsive symptoms, and for weight gain. Evidence of streptococcal infection came from clinical evaluation, throat cultures, and two serological tests: anti-deoxyribonuclease B (anti-DNase B) and anti-streptolysin O (ASO) titers. The "rheumatic" marker D8/17 was also measured. This B-cell alloantigen is associated, in several publications, with poststreptococcal autoimmunity: Rheumatic fever (RF), Sydenham's chorea (SC), and possibly PANDAS obsessive compulsive disorder (OCD) and tic disorders.


RESULTS
There was clinical evidence of possible antecedent streptococcal infection in all four patients, two of whom had comorbid OCD, with possible infection-triggered AN. All four had the rheumatic marker: A percentage of D8/17-positive B cells of 28-38%, with a mean of 33% (12% or more is considered positive for the marker). The patients responded to conventional treatment plus antibiotics with weight restoration and decreased eating disorder and obsessive-compulsive symptoms. Three needed to gain weight and did so.


CONCLUSIONS
There may be a link between infectious disease and some cases of AN, which raises the possibility of new treatment.
Eating Disorders Program, The Menninger Clinic, Topeka, Kansas 66601, USA. sokolms@menninger.edu
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D000293:Adolescent; D000856:Anorexia Nervosa / Q000209:etiology* / Q000523:psychology / Q000534:rehabilitation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000523:psychology*; D002648:Child; D005260:Female; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D008297:Male; D009752:Nutritional Status; D011569:Psychiatric Status Rating Scales; D012852:Sinusitis / Q000150:complications; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D015430:Weight Gain
D000900:Anti-Bacterial Agents; D007075:Immunoglobulin M