When Angela Tang’s teenage son came down with a baffling illness, few households could have been better equipped to deal with it. The family lives in a wealthy Los Angeles suburb. Both parents are doctors — Tang in internal medicine, her husband in infectious disease — and their son, a straight-A student well-liked at school, had been cared for by the family’s pediatrician since birth.
Still, the parents worried as their son’s symptoms appeared, seemingly out of the blue, in September 2018: He’d meticulously line up pencils in groups of five, recite prayers unrelentingly, make homework illegible as he had to erase or cross out every C, D, and F.
Eating, too, became a chore. If he had a contaminating thought while taking a bite, he’d have to spit out the food, wash his mouth, and try again, but the new bite couldn’t have touched the old one. It got to the point where he could only eat mushy or semi-liquid foods carefully placed “in little aliquots on his plate, so that if one bite got contaminated,” it wouldn’t touch the others, Tang said. Before long, she and her husband were working around the clock just to get him through the day.
In a panic, Tang consulted their pediatrician, and recalls the doctor asking an intriguing question: “Has he had any unusual infections recently — because you know about PANDAS, right?”
At the time, Tang knew nothing about PANDAS. She had completed her own medical residency two years before the illness — short for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections — was first outlined in a 1998 paper. That publication detailed how a child’s behavior could change alarmingly after a strep infection, and may include symptoms of obsessive-compulsive behavior and tics. It has also stirred controversy: Many doctors hesitate to diagnose or treat the condition even today.