Sydenham Chorea Managed With Immunoglobulin in Acute Rheumatic Fever

Sydenham chorea (SC) is common in childhood with extensive differential diagnoses, including inherited disease, autoimmunity, endocrine disorders, and infections. SC due to acute rheumatic fever (ARF) is rare. Herein, we present a case of SC in an eight-year-old child who presented with choreiform movements of her face and limbs, including facial grimacing, difficulty walking, and slurred speech. She also had a runny nose and odynophagia. She had two episodes of sore throat in the last two months, and her physical examination was unremarkable except for hypertrophic tonsils and generalized hypotonia. Throat and blood culture were negative for group A streptococcus. Antistreptolysin O titer was 1139 IU/mL, and anti-deoxyribonuclease B titer was 2100 IU/mL, suggesting a recent group A streptococcal infection. Magnetic resonance imaging (MRI) of the brain revealed hyperintense signals in the thalami and corpus striatum. Echocardiogram was normal with no evidence of carditis. She was diagnosed with ARF and was commenced on amoxicillin and valproic acid. Later on, she was started on IVIG due to the persistence of chorea. Her symptoms improved, and she was discharged a week later on oral haloperidol for the next ten days.