262 Obsessive-Compulsive and Related Disorders
ical manifestation of rheumatic fever, which is in turn due to Group A streptococcal in-
fection. Sydenham’s chorea is characterized by a combination of motor and nonmotor
features. Nonmotor feat ures include obsessions, compulsi ons, attention deficit, and emo-
tional lability. Although indi viduals with Sydenh am’s chorea may present with non-
neuropsychiatric features of acute rheumatic fe ver, such as carditis and arthritis, they may
present with obsessive-compu lsive disorder–like symptoms; such individuals should
be diagnosed with obsessive-compulsive and related disorder due to another medical
condition. 
Pediatric autoimmune neuropsychiatric diso rders associated with  streptococcal infec-
tions (PANDAS) has been identified as an other post-infectious autoimmune disorder
characterized by the sudden onset of obsessions, compulsions, and/or tics accompanied
by a variety of acute neuropsychiatric symptoms  in the absence of chorea, carditis, or ar-
thritis, after Group A streptoc occal infection. Although there is a body of evidence that
supports the existence of PANDAS, it remains a controversial diagnosis. Given this ongo-
ing controversy, the description of PANDAS ha s been modified to eliminate etiological
factors and to designate an expanded clinical  entity: pediatric acute-onset neuropsychiat-
ric syndrome (PANS) or idiopathic childhood  acute neuropsychiatric symptoms (CANS),
which deserves further study.
Associated Features Supporting Diagnosis
A number of other medical disorders are know n to include obsessive-compulsive and re-
lated symptoms as a manifestation. Examples  include disorders leading to striatal dam-
age, such as cerebral infarction.