Michael A Munoz1*, Saad Shams1 and Benson A Babu2
1Department of Pediatrics, Jamaica Hospital Medical Center, USA 2Department of Internal Medicine, St. John’s Episcopal Hospital, USAFulltext PDF
Acute Rheumatic Fever (ARF) is rare multisystem, immune-mediated sequelae of an untreated group-A streptococcal infection. Due to its immune-mediated pathogenesis, ARF can present with a variety of different tissue and organ manifestations like arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. The large number of differential diagnosis associated with any one manifestation can make the diagnosis of ARF extremely difficult. It is essential to recognize and treat ARF in order to avoid the long-term morbidity. One of the rarest components of ARF is the manifestation of Sydenham’s chorea. It is an autoimmune, neuropsychiatric movement disorder that makes up the major criteria alone to diagnose ARF. An 8-year-old female presents with a two-week history of worsening involuntary movements, difficulty with speech, and functional decline. On physical examination, the child displays nonrhythmic movements, an abnormal gait, and incomprehensible speech. Her oral pharynx is nonerythematous and no exudates are visualized. A new systolic murmur is appreciated and her Anti- Streptolysin O (ASO) was positive. ARF was diagnosed based on the chorea, new murmur, and also the positive ASO. The patient was administered with one dose of IM penicillin benzathine to treat her ARF and commenced on risperidone to help manage the chorea. ARF is still present in developed nations and hospitalist should be familiar with the varying ways it can present. Sydenham chorea is a disabling feature of ARF that requires early recognition and treatment.
Munoz MA, Shams S, Babu BA. Neurologically Disabling Features of Rheumatic Fever. Ann Clin Case Rep. 2020; 5: 1791..