Strains of Obsessions: Poststreptococcal Obsessive–Compulsive Disorder Explained

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a condition primarily impacting children but with some instances extending beyond this demographic, is closely correlated with streptococcal infections, which can occur across all age groups, including adults. The temporal association between neuropsychiatric symptom exacerbations and streptococcal infections was the major distinguishing feature of the PANDAS subgroup. We have a 23-year-old married female with two children who presented with a 20-day history of symptoms indicative of obsessive–compulsive behavior, including repetitive cleaning, excessive handwashing, and frequent showering, accompanied by marked fearfulness, palpitations, verbal outbursts, and sleep disturbances. Notably, these symptoms followed an episode of high-grade fever, sore throat, and upper respiratory tract symptoms occurring approximately 1 month prior. Laboratory investigations revealed mildly deranged parameters, most significantly elevated antistreptolysin O titers. A two-dimensional echocardiogram indicated mild left ventricular systolic dysfunction with a reduced ejection fraction. The patient was initiated on a regimen comprising antibiotics (including penicillin), selective serotonin reuptake inhibitors, and tricyclic antidepressants, resulting in notable clinical improvement over an 8-month follow-up period.