PANDAS: DIJAGNOSTIČKI I TERAPIJSKI IZAZOVI, PRIKAZ BOLESNICE I PREGLED LITERATURE

Kristian Hodak, Mario Šestan, Marija Jelušić

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is a controversial clinical entity in medical practice due to insufficiently known etiopathogenesis, lack of specific markers for confirmation of the diagnosis, and difficult-to-prove causal relationship between a group A β-haemolytic streptococcal (GABHS) infection and the onset of symptoms. It presents with a sudden onset of symptoms and signs of obsessivecompulsive disorder (OCD) and/or tics, which are associated with a recent GABHS infection. We presented a patient with PANDAS as well as a brief overview of the literature concerning the etiopathogenesis, diagnostics and treatment while emphasizing the complexity of this disorder due to the large variations in clinical presentation, the inability to make a reliable diagnosis, and the controversies in choosing effective treatment methods. It is evident that many of the issues surrounding PANDAS remain open and that further research and a multidisciplinary approach are needed to
better understand this complex clinical entity.

Pedijatrijski autoimunosni neuropsihijatrijski poremećaji udruženi sa streptokoknom infekcijom (engl. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections – PANDAS) prijeporan su klinički entitet u medicinskoj praksi zbog nedovoljno poznate etiopatogeneze, nepostojanja specifičnog biljega za potvrdu dijagnoze te teško dokazive uzročno-posljedične veze između infekcije β-hemolitičkim streptokokom skupine A (BHSA) i pojave simptoma ovog poremećaja. Očituje se naglo nastalim simptomima i znakovima opsesivno-kompulzivnog poremećaja (OKP) i/ili tikovima, koji su povezani s nedavnom infekcijom BHSA-om. U radu smo prikazali bolesnicu s PANDAS-om i kratak pregled literature vezane uz etiopatogenezu, dijagnostiku i liječenje ovog poremećaja pri čemu smo željeli naglasiti njegovu složenost zbog velikih različitosti u kliničkoj slici, nemogućnosti postavljanja sigurne dijagnoze i prijepora pri odabiru učinkovitih metoda liječenja. Iz navedenoga je razvidno da mnoga pitanja u svezi s PANDAS-om ostaju otvorena te da su potrebna daljnja istraživanja i multidisciplinarni pristup kako bi se bolje upoznao ovaj kompleksan klinički entitet.