CLF Woo, KT Liu, BWY Young

Abstract

Acute onset of abnormal involuntary movements in children is an unusual clinical encounter in our daily practice. The differential diagnoses could be quite diversified and often pose management difficulties. Sydenham's chorea is still a common cause in developing countries and should be considered in the differential diagnosis. Sydenham's chorea is a major clinical manifestation in acute rheumatic fever. The other major clinical manifestations are migratory polyarthritis, carditis, subcutaneous nodules and erythema marginatum according to Jones Criteria. The incidence of Sydenham's chorea in acute rheumatic fever varies across the decades and populations studied. From 1920 to 1950, more than half of the patients with rheumatic fever had Sydenham's chorea. The incidence decreased to less than five percent in more recent studies. The often-long latent period between Group A beta-haemolytic streptococcal infection and the onset of chorea makes it an uncommon initial presentation in acute rheumatic fever. We report the clinical findings, investigations and the course of clinical development of a nine-year-old girl, who presented with acute onset of abnormal involuntary movements for a history of three days before her admission. Sydenham's chorea and the treatment of rheumatic fever are reviewed.