Table 1 Red flag symptoms for potential autoimmune OCD as suggested by Endres et al. [30], their presence in the presented cases. See footnotes for suggestions for revised phrasing.
Red Flag | Case 1 | Case 2 | Case 3 | Comment |
|---|---|---|---|---|
1) (SUB)ACUTE ONSET OF OCD ( < 3 MONTHS)a | Yes | Yes | Maybe | Case 3: accentuation of OCD |
2) TREATMENT RESISTANCE DESPITE GUIDELINE-BASED THERAPYb | Yes | Yes | Yes | |
3) ATYPICAL AGE OF ONSET (EARLY CHILDHOOD OR LATER ADULTHOOD) | No | No | No | |
4) ATYPICAL PRESENTATION OF OCD | Yes | Yes | Yes | Cases 1-2: severe hypersomnia; Cases 1-3: loss of function due to disproportionate cognitive deficits |
5) ACCOMPANYING NEUROLOGICAL SIGNS: MOVEMENT DISORDER, FOCAL NEUROLOGICAL DEFICITS; NEW SEIZURES; NEW HEADACHE | No | Yes | Maybe | Case 2: choreatic movements; Case 3: seizures |
6) AUTONOMIC DYSFUNCTION | No | No | No | |
7) ADVERSE RESPONSE TO ANTIPSYCOITICS | No | No | No | |
8) TEMPORAL ASSOCIATION OF ONSET WITH INFECTIONSc, d | No | Maybe | Maybe | Case 2-3: Self-reported, unverified |
9) COMORBID AUTOIMMUNE DISEASE | No | Yes | Maybe | Case 2: Kawasaki’s disease, Case 3: suspected APS |
10) COMORBID MALIGNANCIES (SUCH AS OVARIAN TERATOMA) | No | No | No | |
11) SUSPICIOUS ALTERTIONS IN INVESTIGATIONS: | Yes | Yes | Yes | See below |
A) SERUM: AUTOANTIBODIES (NEURONAL, ANA) | No | Yes | No | Case 2: DRD-1 antibodies, (streptococcal abs. not tested) |
B) EEG: SIGNS OF ENCEPHALOPATHY | - | No | No | |
C) MRI: BASAL GANGLIA/MESIOTEMPORAL HYPERINTENSITIES, INFLAMMATORY LESIONS | No | No | Maybe | Case 3: punctiform subcortical white matter changes |
D) 18FDG-PET: ENCEPHALITIC PATTERNS WITH DISTURBED METABOLISM IN BASAL-GANGLIA, AND ALONG CORTICAL OR TEMPORAL REGIONS | Yes | - | No | Case 1: low uptake in anterior cingulum, right cerebellar hemisphere and medial of the posterior horn |
E) CSF: PLEOCYTOSIS, OCBs, NEURONAL AUTOANTIBODIES, HIGH IgG INDICIES, DAMAGE MARKERS | Yes | No | Yes | Case 1: increased IgG index; Cases 1 + 3: OCBs |
