Case Report of a Singular Presentation of Sydenham’s Chorea in Acute Rheumatic Fever - Abstract
The following case report illustrates the significance of patient history and always having a broad differential diagnosis. A four-year-old boy presented in our clinic with the solitary symptom of intermittent shoulder spasms. The patient’s mother described frequent episodes of twitching lasting twenty to thirty seconds and occurring ten times per day, which concerned her for a possible tic disorder. During his examination, the patient had a single episode of the reported dystonia, which was felt to be choreoathetoid in nature. We were suspicious of an atypical presentation of acute rheumatic fever (ARF), and subsequent laboratory findings revealed a mildly elevated Anti-streptolys in O Antibody (ASO) titer. Focused history-taking uncovered that the patient had a febrile illness and a self-limiting rash one month prior to his presentation for which he did not seek care. After consultation with a pediatric infectious disease specialist, Group A Beta-Hemolytic Streptococcus (GABHS) prophylaxis was started,
and he was referred to cardiology. His cardiologist performed an echocardiogram which demonstrated mild mitral regurgitation that was felt to be highly unusual for a child his age. He was diagnosed by his cardiologist with mitral valvulitis, and it was recommended that he continue Bicillin intramuscular injections for Streptococcal prophylaxis. The ultimate outcome of this case was the diagnosis of ARF in a patient whose only presentation was Sydenham’s chorea. The main take-away from this case was the importance of always considering ARF in a patient who presents with only chorea as his or her primary symptom.