Title: Effective Management of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) in a 15-Year-Old Girl: A Case Report Authors: Varsha Kakani MBBS, Dwija Rajguru, Meet Singh MBBS Keywords: Neuropsychiatric symptoms, Streptococcal infection, Antibiotics, Corticosteroids, SSRI Background & Introduction: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is characterized by sudden onset obsessive-compulsive behavior, tics, and various behavioral issues in children with a history of streptococcal infections. Symptoms include personality changes, cognitive decline, motor disturbances, sensory sensitivity, behavioral changes, and psychosis. Linked to repeated streptococcal infections, PANDAS affects children aged 3 to 12 years, with an incidence of 1 per thousand. The disorder results from molecular mimicry, leading to the production of cross-reactive antibodies that can cross the blood-brain barrier and bind to neuronal antigens like lysoganglioside, dopamine receptors, and CAMK II (calcium/calmodulin-dependent protein kinase II), particularly in the basal ganglia, triggering rapid onset obsessive-compulsive symptoms. Diagnosis and followup relies on elevated Anti-streptolysin O ASO or Anti-DNAse B titers. Treatment involves antibiotics, corticosteroids, and SSRIs to prevent persistent symptoms into adulthood. Case Report: A 15-year-old Puerto Rican girl presented with altered behavior over three weeks, including visual, auditory, and tactile hallucinations, discomfort from seeing numbers shake in class, nausea when looking at certain numbers and letters, and distortions in her reflection. She also experienced eye blinking tics, crawling sensations, significant anxiety, social isolation, and prolonged showers. Despite these symptoms, her sleep and appetite were undisturbed. Her father reported multiple streptococcal throat infections, decreasing after a tonsillectomy at age 10. Recent sore throat symptoms resolved with over-the-counter analgesics. Elevated Anti-DNAse B antibodies (1070 U/ml) and ASO titers (342.1 IU/ml) suggested PANDAS. She was initially treated with Clindamycin due to a penicillin allergy but showed no improvement. The treatment was then switched to Azithromycin, which led to partial improvement. Subsequent treatment with methylprednisolone, naproxen, and sertraline significantly reduced her symptoms within one week, allowing her to refocus on schoolwork. Follow-up ASO titers decreased to 306.8 U/ml. Discussion: This case highlights the diagnostic challenges and therapeutic response in suspected PANDAS. The acute onset of neuropsychiatric symptoms, along with elevated streptococcal antibodies, supported the diagnosis. Initial antibiotics provided partial relief, but significant improvement was achieved with corticosteroids and SSRIs, underscoring the benefit of integrated treatment. Conclusion: PANDAS should be considered in pediatric patients with acute neuropsychiatric symptoms and a history of streptococcal infections. Early recognition and combined antibiotic, corticosteroid, and SSRI therapy can effectively manage PANDAS symptoms.