case_images: PMC4789548_01
case_images: PMC4789548_02
case_images: Clinical and laboratory records. Arrows indicate the times of blood sampling for autoimmunity testing. ASO, anti-streptolysin O antibody (filled circles); anti-DNase B, anti-deoxyribonuclease B antibody (open circles); ESR, erythrocyte sedimentation rate (filled triangles); YGTSS motor, Yale global tic severity score motor subscale (filled squares); YGTSS vocal, Yale global tic severity score vocal subscale (open squares).
case_images: fpsyt-07-00031-g001.jpg
case_images: PMC4789548_02_fpsyt-07-00031-g001.jpg
case_images: F1
case_images: Subsequent laboratory tests showed a significant decrease in the ASO titer to normal levels, along with a decrease in the anti-DNase B titer to reference values (i.e., below 200 IU/mL) (Figure 1). A few months later, the scenario was completely reversed (Figure 1). Parallel blood tests indicated a slight increase in WBC count (Table 1, observation period B), an ASO titer that increased from 47 to 264 IU/mL (Figure 1), an increase in the ESR (Figure 1), and a significantly positive ASTA antibody titer (Table 1, observation period B). Four months later, a S. aureus strain with the same pattern of antibiotic susceptibility as that described above (and possibly the same strain) was again recovered from nostril and tonsil swabs; a significant clinical improvement was also observed (Figure 1). Two months later, close to the end of the second colonization phase, vocal tic frequency and severity (grunts) increased to values never recorded before, with only a slight increase in motor tics (Figure 1).