RESUMEN
OBJECTIVE: The authors' goal was to determine whether a trait marker of rheumatic fever susceptibility (labeled D8/17) could identify children with pediatric autoimmune neuropsychiatric disorders (obsessive-compulsive disorder and tic disorders) associated with streptococcal infections (PANDAS). METHOD: Blood samples obtained from 27 children with PANDAS, nine children with Sydenham's chorea, and 24 healthy children were evaluated for D8/17 reactivity. Individuals were defined as D8/17 positive if they had 12% or more D8/17+ cells. RESULTS: The frequency of D8/17-positive individuals was significantly higher in both patient groups than it was among the healthy volunteers: 85% of the children with PANDAS and 89% of the children with Sydenham's chorea, compared with 17% of the healthy children, were D8/17 positive. Further, the mean number of D8/17+ cells was similar in the two patient groups and was significantly higher in these groups than in the group of healthy children. CONCLUSIONS: These results suggest that there may be a subgroup of D8/17-positive children who present with clinical symptoms of obsessive-compulsive disorder and Tourette's syndrome, rather than Sydenham's chorea, but who have similar poststreptococcal autoimmunity.
Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Biomarcadores , Corea/inmunología , Antígenos HLA-DR/inmunología , Subgrupos Linfocitarios/inmunología , Trastorno Obsesivo Compulsivo/diagnóstico , Fiebre Reumática/inmunología , Infecciones Estreptocócicas/inmunología , Adolescente , Anticuerpos Monoclonales/inmunología , Enfermedades Autoinmunes/inmunología , Niño , Preescolar , Femenino , Predisposición Genética a la Enfermedad , Humanos , Masculino , Fiebre Reumática/genéticaRESUMEN
This report describes a clinical syndrome of a sensory variant of Guillain-Barré syndrome (GBS). A patient presented at our medical center with symptoms that began two weeks after she had had a normal childbirth. Symptoms included acute, rapidly progressive, and symmetrical sensory loss; areflexia; and mild nonprogressive weakness. Nerve conduction studies done at the time of her admission showed late response abnormalities consistent with GBS. Follow-up studies one week later were consistent with a predominantly sensory neuropathy with minimal motor deficits. Within a few months, both her sensory symptoms and motor weakness had markedly improved. Except for the predominance of sensory rather than motor deficits, these findings are consistent with those of GBS. The case for a sensory variant of GBS is further supported by autopsy findings as described by Dawson and associates.