Paediatric acute-onset neuropsychiatric syndrome (PANS) with trichotillomania

This report describes a child diagnosed with a presentation consistent with paediatric acute-onset neuropsychiatric syndrome (PANS), accompanied by obsessive-compulsive symptoms and trichotillomania. A school-aged girl in middle childhood developed sudden-onset washing rituals, contamination fears, hair-pulling behaviour and progressive academic decline shortly after a severe throat infection. Her symptoms included prolonged handwashing, repetitive utensil cleaning and recurrent hair pulling resulting in a patch of incomplete alopecia. Psychiatric assessment confirmed moderate obsessive-compulsive symptom severity, and dermatological evaluation supported a behavioural origin of hair loss consistent with trichotillomania. Comprehensive investigations including blood tests, neuroimaging, electroencephalography, abdominal ultrasound and cognitive testing were unremarkable except for elevated anti-streptolysin O (ASO) titres, indicating a past streptococcal illness. She was treated with fluoxetine, behavioural therapy and family psychoeducation, leading to a gradual reduction in compulsive behaviours, decreased hair pulling, improved daily functioning and early hair regrowth over 3 months.