Glenn-Porter, Bernadette, BS

Kane, Kathleen E, MD

Mazzaccaro, Richard J, MD

Myers, Paul J, DO

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works Department of Emergency Medicine Sydenham Chorea: Rare Consequence of Rheumatic Fever. Paul J. Myers DO Lehigh Valley Health Network, Paul_J.Myers@lvhn.org Kathleen E. Kane MD Lehigh Valley Health Network, kathleen_e.kane@lvhn.org Bernadette Glenn-Porter BS Lehigh Valley Health Network, Bernadette.GI-Porter@lvhn.org Richard J. Mazzaccaro MD Lehigh Valley Health Network, Richard.Mazzaccaro@lvhn.org Follow this and additional works at: https://scholarlyworks.lvhn.org/emergency-medicine  Part of the Emergency Medicine Commons Published In/Presented At Myers, P. J., Kane, K. E., Porter, B. G., & Mazzaccaro, R. J. (2014). Sydenham chorea: rare consequence of rheumatic Fever. The Western Journal Of Emergency Medicine, 15(7), 840. doi:10.5811/westjem.2014.8.22981 This Article is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Western Journal of Emergency Medicine 840 Volume XV, NO. 7 : November 2014Images In emergency medIcIne Sydenham Chorea: Rare Consequence of Rheumatic Fever Paul J. Myers, DO*Kathleen E. Kane, MD*Bernadette G. Porter, BS*Richard J. Mazzaccaro, MD, PhD † Supervising Section Editor: Sean O. Henderson, MDSubmission history: Submitted July 9, 2014; Accepted August 20, 2014  Electronically published September 19, 2014        Full text available through open access at http://escholarship.org/uc/uciem_westjem   DOI: 10.5811/westjem.2014.8.22981[West J Emerg Med. 2014;15(7):840.]CASE REPORTSydenham Chorea (SC) is an acute rheumatic fever complication. SC is the most common acquired childhood chorea, usually affecting children five to fifteen years of age.1 It occurs following an untreated group A streptococcal infection and a latent period of one to six months.1,2 Despite rheumatic fever diminishing, 18% to 36% of acute rheumatic fever patients develop SC.3 Full recovery often takes several months; some patients suffer permanent neurologic sequelae.1  An 11-year old male presented to the Emergency Department with two days of uncontrolled body twitching. The movements affected his right arm and leg, with occasional lip twitches; he experienced intermittent confusion and hyperactivity. The patient denied recent illness, but recalled a fever with headache and vomiting several months prior. Besides the above findings, his physical examination was normal.  The patient’s rapid streptococcal antigen test was negative, but his throat culture was positive for group A beta hemolytic Streptococcus. An anti-streptolysin O (ASO) titer resulted at 503 (reference range, <240 IU/mL). Symptoms progressed to include slurred speech, head jerking, awkward gait, and decreased right eye vision.  Several motor manifestations are pathognomonic: “Milkmaid’s grip” occurs when patients are unable to clench their fists, displaying as intermittent relaxation and tightening of hand grip.1 “Choreic hand” is “spooning” of the hand by wrist flexion and extension of the digits.1 The linked video demonstrates this patient’s motor manifestations (Video).   Evaluation of chorea in pediatric patients should include testing for group A streptococcal infection with throat culture and ASO titers. SC is key to diagnosing rheumatic fever and should Lehigh Valley Health Network/USF MCOM, Department of Emergency Medicine, Allentown, PennsylvaniaLehigh Valley Health Network, Department of Pediatrics, Allentown, Pennsylvania*†prompt evaluation for rheumatic heart disease. This patient’s brain magnetic resonance imaging and electrocardiogram were normal, but his echocardiogram showed mild mitral regurgitation. Treatment included penicillin for ten days, instructions to get monthly bicillin injections through age twenty-one and a recommendation for lifelong antibiotic prophylaxis.Video. Motor manifestations of patient.Address for Correspondence: Bernadette Porter, EM Residency Suite, 2545 Schoenersville Road, Bethlehem, PA, 18017. Email: Bernadette.Gl-Porter@lvhn.org.Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.      REFERENCES  1. Weiner S, Normandin P.  Sydenham chorea: a case report and re-view of the literature. Ped Emerg Care. 2007;23(1):20-4.2. Peña J, Mora E, Cardozo J, et al. Comparison of the efficacy of carbamazepine, haloperidol and valproic acid in the treatment of children with Sydenham’s chorea: Clinical follow-up of 18 patients. Arq Neuropsiquiatr. 2002; 60(2-B):374-77.3. van Immerzeel TD, van Gilst RM, Hartwig NG. Use of immuno-globulins in the treatment of Sydenham chorea. Eur J Pediatr. 2010; 169(9):1151–54.

Sydenham Chorea: Rare Consequence of Rheumatic Fever.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1282&context=emergency-medicine

Sydenham Chorea: Rare Consequence of Rheumatic Fever.

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Lehigh Valley Health Network: LVHN Scholarly Works