Moleculera Labs Educational Series:

Case report: Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult

Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult

“We present a unique case of a 31-year-old female admitted with involuntary movements of the upper extremities of three weeks duration. Her movements start as twitching before progressing to one hand hitting the other or hitting her face.” 3

“After a detailed workup, including a negative magnetic resonance imaging (MRI) of the brain with and without contrast, MRI of the spine, computed tomography of the chest, abdomen, and pelvis for neoplasia, as well as blood work for autoimmunity, infections, and paraneoplastic syndrome, the serology came back strongly positive for antistreptolysin O and antideoxyribonuclease B titers.”

“Our case report highlights the importance of a thorough history, including inquiring about past infections and investigations to look for autoimmune and infectious etiologies, including ASO and positive DNAse B titers, in adult patients with new onset movement disorders and no other identifiable etiology and risk factors.”

“There are several limitations to our study. First, since our patient presented two months after the onset of symptoms, we cannot definitively establish the temporal relationship between the movement disorder and GABHS. She had considerable overlap between the symptoms and signs of organic and functional/psychogenic tics, providing diagnostic difficulty. In addition, after discharge, she was lost to follow-up; therefore, subsequent progression of symptoms could not be studied, including the development of any neuropsychiatric symptoms and exacerbation or remission of movements.”



  1. Ayşegül Efe, SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents, Psychiatry Research Case Reports, Volume 1, Issue 2, 2022, 100074, ISSN 2773-0212, https://doi.org/10.1016/j.psycr.2022.100074.
  2. Trifiletti R, Lachman HM, Manusama O, Zheng D, Spalice A, Chiurazzi P, Schornagel A, Serban AM, van Wijck R, Cunningham JL, Swagemakers S, van der Spek PJ. Identification of ultra-rare genetic variants in pediatric acute onset neuropsychiatric syndrome (PANS) by exome and whole genome sequencing. Sci Rep. 2022 Jun 30;12(1):11106. doi: 10.1038/s41598-022-15279-3. PMID: 35773312; PMCID: PMC9246359.
  3. Ilyas U, Umar Z, Lin D (August 26, 2022) Group A Beta-Hemolytic Streptococcus-Induced Tic-Like Movement Disorder in an Adult: A Case Report. Cureus 14(8): e28451. doi:10.7759/cureus.28451.
  4. Soltani Khaboushan A, Pahlevan-Fallahy M-T, Shobeiri P, Teixeira AL, Rezaei N (2022) Cytokines and chemokines profile in encephalitis patients: A meta-analysis. PLoS ONE 17(9): e0273920. https://doi.org/10.1371/journal.pone.0273920.