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Accidental Fall Due to Abnormal Behavior After Experiencing a Streptococcus pyogenes Infection: Febrile Delirium or Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infection?

Yanagawa, Youichi MD, PhD*; Kaneko, Naoyuki MD*; Higashidate, Seiki MD*; Matsumoto, Hiroshi MD, PhD

doi: 10.1097/PEC.0b013e3181b0a4af
Illustrative Cases

An 11-year-old boy with a high fever (39.4°C) presented at a local medical institution. His condition was diagnosed as hemolytic streptococcal infection, and he was prescribed an antibiotic. After returning home, he took a dose of his medication and rested; however, he suddenly began to run around while yelling incomprehensible words. He ran up to his room on the second floor and fell from the second floor window down to the ground. He lost consciousness and was transferred to our department. His history included being born as a twin with a low birth weight and pneumonia at 1 year of age. He regained consciousness on the seventh hospital day and was discharged without any neurological abnormality on the 14th day. His abnormal behavior might have resulted from febrile delirium or an unusual expression of pediatric autoimmune neuropsychiatric disorder associated with a streptococcal infection.

From the Department of *Traumatology and Critical Care Medicine, and †Pediatrics, National Defense Medical College, Tokorozawa, Saitama, Japan.

Reprints: Youichi Yanagawa, MD, PhD, Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan 359-8513 (e-mail:

Support and funding: None.

© 2009 Lippincott Williams & Wilkins, Inc.