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+Eight-year-old patient with no personal or family history of interest. She came to the emergency department because, coinciding with a catarrhal process with odynophagia without fever, she suddenly presented with coprolalia, selective memory disorder (she did not remember and confused some names of people she knew), anomalous behaviour with hyperactivity and compulsive movements. He does not lose consciousness and there is no alteration of muscle tone or strength. The family describes the picture as an explosive and surprising behavioural alteration. The episode lasts a few minutes and when he arrives at the emergency department he is calmer, although he continues to show language alterations and confusion in relation to his family and the environment in which he finds himself. He reports catarrhal symptoms and a sore throat. He is afebrile.
+No exanthema was observed on examination; cardiopulmonary auscultation was normal. ENT examination: tonsillar exudation. Abdomen: soft, without visceromegaly. Sensitivity, tone, strength and osteotendinous reflexes are normal. There were no signs of neurological focality.
+Blood tests showed 18 400 leukocytes (86 segmented, three segmented, three white blood cells, six lymphocytes, three monocytes), and 260 000 platelets. Biochemistry with no alterations in the basic screening, C-reactive protein (CRP): 11 mg/l. A throat swab was taken and was positive for Streptococcus pyogenes (group A).
+She was admitted for observation and study of the process and antibiotic treatment was started with amoxicillin, which ended ten days later. The neuropsychiatric symptoms disappeared completely 24 hours after admission. Given the rapid resolution and the child's good general condition, it was decided to discharge him from hospital and continue with outpatient treatment.
+When we saw him at the primary care clinic, the patient was asymptomatic, with no alterations in the physical and neurological examination. Cranial magnetic resonance imaging and electroencephalogram were requested and found to be normal. He was seen for a catarrhal process three months later, with no recurrence of the symptoms described in the previous episode of tonsillitis. He remained without relapses.
+He has undergone tonsillar exudate tests on two occasions for infectious processes, both of which were negative. Carrier status has also been ruled out, although anti-streptolysin O (ASLO) antibody levels have not been determined as there have been no further clinical relapses.
+