Case 1
An 8 year old Caucasian girl from Upstate New York was brought to our offices for a consultation on August 3, 2006. Following a documented Group A Beta Hemolytic Streptococcus infection on February 6, 2005 she had a sudden onset of obsessive-compulsive symptoms (leaf picking, repeating phrases, constantly seeking reassurance, hoarding of trash, picking food wrappers and paper scraps from the garbage, unusual bathroom rituals, such as turning lights on and off, clicking toilet seat 5 times) and vocal tics (grunting, constant throat clearing). There were also severe and debilitating behavioral changes (emotional lability, moodiness, irritability, and extreme separation anxiety). In addition, her fine motor skills (particularly handwriting and drawing) deteriorated noticeably as well as her math skills and ability to concentrate.
During the ensuing 15 months her clinical course exhibited clear "wax-and-wane" pattern, where her OCD symptoms would decrease over a period of time only to be re-ignited by even minor infectious episodes (usually a viral upper respiratory tract infection). The quality and the intensity of her OCD symptoms would change in time. Episodes of running in circles 150 times a day, with a stiff "routine" of 10 runs clockwise and 10 runs counterclockwise would be later substituted by sudden fear of contamination of her parents and grandparents with urine or germs, insistence on symmetry, obsessions with death and/or natural disasters, etc. However, her debilitating separation anxiety and diminished fine motor skills would not improve significantly even during the periods of diminished OCD symptoms.
Her treatment included several courses of antibiotics (usually there was an immediate, but incomplete remission of her OCD symptoms), tonsillectomy (in April 2005), and several attempts to control her symptoms with SSRI. All of these treatments had only temporary effect and by spring/summer of 2006 she became completely incapacitated, home bound,