Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase

Alperen Kılıç; Nesibe Boyraz; Battal Emre Şahin; Tuğrul Elverdi; Mehmet Yücel Ağargün

doi:10.5455/PBS.20251228033259

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Online Published: 17 Oct 2026

PBS. 2026; 16(4): 266-269

doi: 10.5455/PBS.20251228033259

Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase

Alperen Kılıç, Nesibe Boyraz, Battal Emre Şahin, Tuğrul Elverdi, Mehmet Yücel Ağargün.

Abstract
Objective: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) represent a specific autoimmune response to group A streptococcal (GAS) infections in children and adolescents with neuropsychiatric disorders, including sudden onset obsessive-compulsive disorder (OCD) or tic symptoms.

Case presentation: We present a case report of a 20-year-old male adult patient with Tourette Syndrome (TS) within the PANDAS spectrum who underwent a gradual treatment approach. This is, to our knowledge, the first reported case documenting the effects of penicillin and plasmapheresis treatments in a PANDAS patient with delayed sleep phase. Our patient first exhibited motor tics at age six following frequent throat infections. Despite periods of continued tics, the patient presented to us with both motor and vocal tics. Anti-streptolysin O (ASO) levels were elevated. The patient, who did not respond adequately to conventional psychotropic medication, was transitioned to intramuscular depot penicillin treatment and showed a positive response. Subsequently, plasmapheresis treatment led to near-complete resolution of symptoms, achieving remission.

Conclusion: Our report is noteworthy for three reasons: it is a rare case presenting a successful and gradual treatment approach in an adult patient with TS in the PANDAS spectrum. It demonstrates a synchronized dramatic reduction in both symptoms and ASO levels through strict psychometric and ASO measurements. Additionally, it shows parallel improvement in the delayed sleep phase.

Key words: Delayed sleep phase, Tic disorders, Tourette syndrome, PANDAS, Plasmapheresis

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Pubmed Style

Kılıc A, Boyraz N, Şahin BE, Elverdi T, Ağargun MY. Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase. PBS. Online First: 17 Oct, 2026.

doi:10.5455/PBS.20251228033259

Web Style

Kılıc A, Boyraz N, Şahin BE, Elverdi T, Ağargun MY. Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase. https://www.pbsciences.org/?mno=304783 [Access: October 17, 2026].

doi:10.5455/PBS.20251228033259

AMA (American Medical Association) Style

Kılıc A, Boyraz N, Şahin BE, Elverdi T, Ağargun MY. Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase. PBS. Online First: 17 Oct, 2026.

doi:10.5455/PBS.20251228033259

Vancouver/ICMJE Style

doi:10.5455/PBS.20251228033259

Harvard Style

Kılıc, A., Boyraz, . N., Şahin, . B. E., Elverdi, . T. & Ağargun, . M. Y. (2026) Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase. PBS, Online First: 17 Oct, 2026.

doi:10.5455/PBS.20251228033259

Turabian Style

Kılıc, Alperen, Nesibe Boyraz, Battal Emre Şahin, Tuğrul Elverdi, and Mehmet Yucel Ağargun. 2026. Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase. Psychiatry and Behavioral Sciences, Online First: 17 Oct, 2026.

doi:10.5455/PBS.20251228033259

Chicago Style

Kılıc, Alperen, Nesibe Boyraz, Battal Emre Şahin, Tuğrul Elverdi, and Mehmet Yucel Ağargun. "Remission Achieved With Gradual IM Penicillin and Plasmapheresis Treatment in an Adult Case with Tourette Syndrome in the PANDAS Spectrum With Delayed Sleep Phase." Psychiatry and Behavioral Sciences Online First: 17 Oct, 2026.

doi:10.5455/PBS.20251228033259

MLA (The Modern Language Association) Style

doi:10.5455/PBS.20251228033259

APA (American Psychological Association) Style

doi:10.5455/PBS.20251228033259

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