Movement Disorder, Suicidal Ideation and Depression Related to Streptococcal Infection

Purpose: Following streptococcal infections, children appear to develop neurologic and psychiatric symptoms. We describe two cases of pediatric patients who developed a wide array of neurologic symptoms during or just after streptococcal infections, as measured by elevated ASO titers. Materials and Methods: The medical history and clinical outcomes of the patients were obtained. Patient 1 is a ten year old who presented at age 8 with anxiety and core muscle spasms that culminated in bilateral ballismus and tremors on the right side. He was seen by Neurology and Infectious Disease. Patient 2 is a 10 year old male with one month of insomnia and suicidal thoughts that were beyond his control. Evalauation included CXR, ESR, CBC, CMP and ASO titer and urgent outpatient psycology evaluation. Results: An elevated ASO titer was the only abnormal lab for Patient 1. He improved in 36 hours on oral Cefdinir. Neurology and Infectious Disease were unable to establish a definitive diagnosis. He has had two relapses of chorea like abdominal movements associated with anxiety that both improved with Cefdinir. He improved in 72 hours after starting treatment with Cefdinir and to date is symptom free. Patient 2 had an elevated ASO. He improved in 72 hours after starting treatment with Cefdinir and to date is symptom free. Conclusion: These cases demonstrate that clinicians should consider prior streptococcal infections in the differential of acute neuorologic or psychiatric symptoms.