I think this is a really great question and one that may be debated for along time.
We are a family of four with Lyme and only one dx'd with PANS. PANS child is by far the sickest if you exclude my cancer dx. She has been dx'd with CVID, PANS, Lyme & Co & Eosinophilic Esogphagitis. Plus she has some yet clearly undefined problem with her right kidney that Dr's monitor yearly. She has had three periods where her sx's/illness was clearly more PANS and treatment of underlying infection (2 Pseudomonas & 1 Strep related) "cured" sx's. Currently, I believe her PANS is in remission. However, like ChristianMoms child, whenever she is ill her sx tend to be PANS like. No matter what is going on in her body, she always has leg pain, headaches, and mood issues that border on raging. BUT the mood issues are short lived, can generally be linked back to a trigger within four hours, and she is usually in more "control"-meaning she is able to say, I can't stop myself, leave me alone so I can calm down. So PANS like but definitely different.
DS12 had ASO titers of 1100 and Dnase in the 400's when dx'd with lyme but no PANS sx. He actually had more typical EE sx. A year after starting tx his ASO is still in the 400's I believe but he has never had raging or PANS sx.
DH has elevated Dnase but normal ASO titers. I have both normal Dnase & ASO but I recently failed a Pneumo Vax challenage and have low IgG totals, and Subclass 1 & 3; so I am headed towards a dx of CVID myself.
So everyone in our family clearly has issues with strep but only one has the severe sx associated with PANS.