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Stuttering onset associated with streptococcal infection: A case suggesting stuttering as PANDAS

Gerald A. Maguire, MD

Associate Professor of Clinical Psychiatry, Kirkup Endowed Chair in Stuttering Treatment, Senior Associate Dean, Educational Affairs, University of California, Irvine Medical Center, Orange, CA, USA

Steven N. Viele, MD, FAAP

Pediatrician, Private Practice, Laguna Beach, CA, USA

Sanjay Agarwal, MD*

Resident, University of California, Irvine Medical Center, Orange, CA, USA

Elliot Handler, BA*

Student, University of California, Irvine Medical Center, Orange, CA, USA

David Franklin, PsyD*

Assistant Clinical Professor, Department of Psychiatry, University of California, Irvine Medical Center, Orange, CA, USA

* At the time of this letter, Drs. Agarwal and Franklin and Mr. Handler were at these respective affiliations.


We report the case of a 6-year-old male with the sudden onset of stuttering approximately 1 month after a documented streptococcal infection. The patient had no known family history of stuttering. Six months prior to an evaluation for stuttering, the patient presented to his pediatrician for complaints of a sore throat, fever, and general malaise. A rapid streptococcus antigen test was performed at the time and was found to be positive (Genzyme Strep A Test OSOM). Choosing to avoid medications, the parents declined antibiotics. One month later, the patient developed the acute onset of stuttering characterized by sound and syllable repetitions and silent blocking of speech. Three months later, he developed characteristic struggle behaviors of stuttering, facial grimaces and head twitches when a stuttering event occurred while speaking. Five and one-half months after his initial diagnosis of a streptococcal infection, the patient continued to have a positive rapid streptococcus antigen test, an antistreptolysin O (ASO) titer of 400 IU/ml (age-specific normal <200 IU/ml) and an antideoxyribonuclease B (anti-DNase B) titer of 387 U/ml (normal=0 to 70 U/ml). He then began amoxicillin/clavulanic acid, 800 mg/d for 10 days with near resolution of stuttering symptoms within 2 weeks. Streptococcal throat culture after the antibiotic course was negative. The patient remained without stuttering symptoms at the time of this submission (6 months later).

CORRESPONDENCE: Gerald A. Maguire, MD, University of California, Irvine Medical Center, Department of Psychiatry, 101 The City Drive, Orange, CA 92868 USA, E-MAIL:
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