Abstract
This is a report of an 11-year-old, prepubertal boy with acute-onset urinary urgency and frequency, obsessions and compulsions related to urination, severe mood lability, inattention, impulsivity, hyperactivity, and intermittent periods of immobilization. Fever, cough, otitis, and sinusitis preceded neuropsychiatric symptoms. Antistreptolysin O and DNAse B antibody titers were elevated, and magnetic resonance imaging revealed bilateral diffuse caudate nuclei swelling. Plasmapheresis resulted in significant and rapid clinical improvement of obsessive-compulsive disorder symptoms and a simultaneous decrease in basal ganglia swelling, consistent with an immune-mediated pathophysiological process involving group A beta-hemolytic streptococci. Hyperactivity, impulsivity, and inattention improved with lorazepam, suggesting that the attention-deficit/hyperactivity disorder symptoms could be manifestations of catatonia.
MeSH terms
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Attention Deficit Disorder with Hyperactivity / diagnosis
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Attention Deficit Disorder with Hyperactivity / psychology
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Attention Deficit Disorder with Hyperactivity / therapy
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Autoimmune Diseases / diagnosis
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Autoimmune Diseases / psychology
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Autoimmune Diseases / therapy*
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Basal Ganglia Diseases / diagnosis
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Basal Ganglia Diseases / psychology
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Basal Ganglia Diseases / therapy*
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Catatonia / diagnosis
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Catatonia / psychology
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Catatonia / therapy*
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Caudate Nucleus / pathology
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Cerebral Ventricles / pathology
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Child
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Combined Modality Therapy
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Humans
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Image Processing, Computer-Assisted
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Lorazepam / therapeutic use*
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Magnetic Resonance Imaging
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Male
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Neurocognitive Disorders / diagnosis
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Neurocognitive Disorders / psychology
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Neurocognitive Disorders / therapy*
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Obsessive-Compulsive Disorder / diagnosis
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Obsessive-Compulsive Disorder / psychology
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Obsessive-Compulsive Disorder / therapy*
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Plasmapheresis*
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Putamen / pathology
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Streptococcal Infections / diagnosis
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Streptococcal Infections / psychology
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Streptococcal Infections / therapy*
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Streptococcus pyogenes*
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Treatment Outcome