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Sydenham's Chorea as Presentation of Rheumatic Heart Disease
A Joshi1, R P B Shrestha1, P S Shrestha1
1Department of Pediatrics, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.
Insights
Sydenham's chorea, a neurological sign of rheumatic fever, can present with involuntary movements. Early diagnosis and treatment of this condition and associated Rheumatic Heart Disease are crucial for favorable outcomes.
Area of Science:
- Pediatric Neurology
- Rheumatology
- Cardiology
Background:
- Sydenham's chorea is the most common acquired chorea in childhood, linked to rheumatic fever.
- Rheumatic fever can lead to Rheumatic Heart Disease, affecting heart valves.
Observation:
- A 13-year-old girl presented with involuntary limb movements, gait instability, and a heart murmur.
- Cardiovascular examination revealed thickened aortic and mitral valves with mitral regurgitation.
- Elevated Anti-streptolysin O titer confirmed a recent streptococcal infection.
Findings:
- The patient was diagnosed with Rheumatic Heart Disease and Sydenham's chorea.
- Brain CT scan was normal, ruling out other neurological causes.
- Symptoms resolved spontaneously within 3 months with Benzathine penicillin prophylaxis.
Implications:
- This case highlights the importance of considering Sydenham's chorea and Rheumatic Heart Disease in pediatric patients with relevant symptoms.
- Prompt diagnosis and management are vital, despite decreasing incidence.
- Regular prophylaxis is essential to prevent recurrent rheumatic fever and cardiac complications.
Abstract:
Sydenham's chorea is the most common type of acquired chorea in childhood which is a major neurological manifestation of rheumatic fever. We describe a 13 years old girl who presented with weakness and purposeless involuntary movements of upper and lower limbs. The symptoms slightly affected the child's daily activities and had an unstable gait on walking which was aggravated during stress. Grade II ejection systolic murmur was noticed on cardiovascular examination. Echocardiography evaluation showed thickened aortic and mitral valve leaflets with mild to moderate degree of mitral regurgitation. Anti-streptolysin O titer was positive (≥200 IU/ml). CT scan of brain was normal. Subsequently child was diagnosed as Rheumatic heart disease with Sydenham's chorea and kept on regular Benzathine penicillin prophylaxis. Symptoms subsided spontaneously after 3 months without any further complications. Although decreasing, early diagnosis and management of Sydenham's chorea and Rheumatic heart disease are very crucial and should be considered with such presentation.
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