Distinguishing PANDAS from Sydenham's chorea: case report and review of the literature.
Children with Sydenham's chorea and PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal throat infections) share an array of neuropsychiatric symptoms and distinguishing one from the other, especially at onset can prove challenging. It is, however, important to distinguish between these two post-streptococcal disorders since their response to therapy differs. Children with Sydenham's chorea require long-term benzathine penicillin prophylaxis to reduce the risk of rheumatic heart disease. In contrast, the efficacy of penicillin prophylaxis in preventing tic or obsessive-compulsive symptom exacerbations in children with PANDAS remains doubtful. Immunomodulatory therapies such as plasma exchange and intravenous immunoglobulin have shown to reduce neuropsychiatric symptom severity in children with PANDAS. Tonsillectomy may also represent an effective treatment option in children severely affected by PANDAS. We present this case to demonstrate the pitfalls in differentiating between these two closely associated conditions in a developing country where the prevalence of rheumatic fever is high.
van Toorn
Ronald
R
Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, P.O. Box 19063, Tygerberg 7505, Cape Town, South Africa. vtoorn@sun.ac.za
Weyers
Henriete H
HH
Schoeman
Johan F
JF
D002648:Child; D002819:Chorea / Q000175:diagnosis* / Q000628:therapy; D003937:Diagnosis, Differential; D006220:Haloperidol / Q000008:administration & dosage; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009460:Neurologic Examination; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000628:therapy; D010406:Penicillins / Q000008:administration & dosage; D011129:Polyradiculoneuropathy / Q000175:diagnosis* / Q000628:therapy; D011595:Psychomotor Agitation / Q000175:diagnosis* / Q000628:therapy; D012008:Recurrence; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000628:therapy; D014069:Tonsillitis / Q000175:diagnosis* / Q000628:therapy
D010406:Penicillins; D006220:Haloperidol