Chorea as the only presenting clinical feature of rheumatic fever: a case report
Introduction and importanceSydenham's chorea (SC), a major neurological manifestation of acute rheumatic fever (ARF), is commonly seen in young children and adolescents. It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can...
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Veröffentlicht in: | Annals of medicine and surgery (2012) 2024, Vol.86 (4), p.2162-2166 |
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description | Introduction and importanceSydenham's chorea (SC), a major neurological manifestation of acute rheumatic fever (ARF), is commonly seen in young children and adolescents. It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can also be associated with clinical or subclinical carditis. SC has been reported as a major manifestation in only 3.87% cases of acute rheumatic fever in Nepal.Case presentationThe authors report a case of a 12-year-old boy with abnormal movement of his right hand and unsteady gait for 12 days. On examination, he had an abnormal hand grip with difficulty maintaining a tetanic contraction (Milkmaid's grip). Laboratory investigations revealed increased anti-Streptolysin O titre and erythrocyte sedimentation rate. Echocardiography revealed subclinical carditis. After thorough clinical examination and pertinent investigations, the final diagnosis of ARF with SC was made.Clinical discussionSC is a major clinical feature of rheumatic fever according to the revised Jones criteria. It is related to a previous Group A β-haemolytic Streptococcus pyogenes (GABHS) infection. Approximately 50-65% of the patients with rheumatic fever later develop clinically detectable carditis. Although a self-limiting condition, it might need treatment with antiepileptics, neuroleptics, and phenothiazines.ConclusionAny child presenting with a movement disorder should also be considered for SC, necessitating additional testing, including a cardiovascular assessment. It needs to be distinguished from other causes of movement disorders as well as psychiatric conditions. Treatment is necessary for moderate to severe chorea that interfere with daily activities. Compliance with subsequent antibiotic prophylaxis is essential for avoiding future cardiac complications. |
doi_str_mv | 10.1097/MS9.0000000000001798 |
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It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can also be associated with clinical or subclinical carditis. SC has been reported as a major manifestation in only 3.87% cases of acute rheumatic fever in Nepal.Case presentationThe authors report a case of a 12-year-old boy with abnormal movement of his right hand and unsteady gait for 12 days. On examination, he had an abnormal hand grip with difficulty maintaining a tetanic contraction (Milkmaid's grip). Laboratory investigations revealed increased anti-Streptolysin O titre and erythrocyte sedimentation rate. Echocardiography revealed subclinical carditis. After thorough clinical examination and pertinent investigations, the final diagnosis of ARF with SC was made.Clinical discussionSC is a major clinical feature of rheumatic fever according to the revised Jones criteria. It is related to a previous Group A β-haemolytic Streptococcus pyogenes (GABHS) infection. Approximately 50-65% of the patients with rheumatic fever later develop clinically detectable carditis. Although a self-limiting condition, it might need treatment with antiepileptics, neuroleptics, and phenothiazines.ConclusionAny child presenting with a movement disorder should also be considered for SC, necessitating additional testing, including a cardiovascular assessment. It needs to be distinguished from other causes of movement disorders as well as psychiatric conditions. Treatment is necessary for moderate to severe chorea that interfere with daily activities. Compliance with subsequent antibiotic prophylaxis is essential for avoiding future cardiac complications.</description><identifier>ISSN: 2049-0801</identifier><identifier>EISSN: 2049-0801</identifier><identifier>DOI: 10.1097/MS9.0000000000001798</identifier><language>eng</language><ispartof>Annals of medicine and surgery (2012), 2024, Vol.86 (4), p.2162-2166</ispartof><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>780,784,4490,27925</link.rule.ids></links><search><creatorcontrib>Thapa, Santosh</creatorcontrib><creatorcontrib>Raut, Ujwal</creatorcontrib><creatorcontrib>Shrestha, Garima</creatorcontrib><creatorcontrib>Shah, Sandesh</creatorcontrib><creatorcontrib>Helmu, Mangal Bahadur</creatorcontrib><title>Chorea as the only presenting clinical feature of rheumatic fever: a case report</title><title>Annals of medicine and surgery (2012)</title><description>Introduction and importanceSydenham's chorea (SC), a major neurological manifestation of acute rheumatic fever (ARF), is commonly seen in young children and adolescents. It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can also be associated with clinical or subclinical carditis. SC has been reported as a major manifestation in only 3.87% cases of acute rheumatic fever in Nepal.Case presentationThe authors report a case of a 12-year-old boy with abnormal movement of his right hand and unsteady gait for 12 days. On examination, he had an abnormal hand grip with difficulty maintaining a tetanic contraction (Milkmaid's grip). Laboratory investigations revealed increased anti-Streptolysin O titre and erythrocyte sedimentation rate. Echocardiography revealed subclinical carditis. After thorough clinical examination and pertinent investigations, the final diagnosis of ARF with SC was made.Clinical discussionSC is a major clinical feature of rheumatic fever according to the revised Jones criteria. It is related to a previous Group A β-haemolytic Streptococcus pyogenes (GABHS) infection. Approximately 50-65% of the patients with rheumatic fever later develop clinically detectable carditis. Although a self-limiting condition, it might need treatment with antiepileptics, neuroleptics, and phenothiazines.ConclusionAny child presenting with a movement disorder should also be considered for SC, necessitating additional testing, including a cardiovascular assessment. It needs to be distinguished from other causes of movement disorders as well as psychiatric conditions. Treatment is necessary for moderate to severe chorea that interfere with daily activities. Compliance with subsequent antibiotic prophylaxis is essential for avoiding future cardiac complications.</description><issn>2049-0801</issn><issn>2049-0801</issn><fulltext>true</fulltext><rsrctype>report</rsrctype><creationdate>2024</creationdate><recordtype>report</recordtype><recordid>eNqVyjELwjAQBeAgCor6DxxudFGTtmrrKoqLIOguR7jaSExqLhX89yo4uPqW93h8QoyUnCpZLGf7YzGVP1HLIm-JXiKzYiJzqdo_uyuGzNcPkvN0sch74rCufCAEZIgVgXf2CXUgJheNu4C2xhmNFkrC2IQ3KCFU1NwwGv0-HxRWgKCRCQLVPsSB6JRomYbf7ovxdnNa7yZ18PeGOJ5vhjVZi458w-dUplmSqUwl6R_0Be7VSks</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Thapa, Santosh</creator><creator>Raut, Ujwal</creator><creator>Shrestha, Garima</creator><creator>Shah, Sandesh</creator><creator>Helmu, Mangal Bahadur</creator><scope>7X8</scope></search><sort><creationdate>20240401</creationdate><title>Chorea as the only presenting clinical feature of rheumatic fever: a case report</title><author>Thapa, Santosh ; Raut, Ujwal ; Shrestha, Garima ; Shah, Sandesh ; Helmu, Mangal Bahadur</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_miscellaneous_30342414123</frbrgroupid><rsrctype>reports</rsrctype><prefilter>reports</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>online_resources</toplevel><creatorcontrib>Thapa, Santosh</creatorcontrib><creatorcontrib>Raut, Ujwal</creatorcontrib><creatorcontrib>Shrestha, Garima</creatorcontrib><creatorcontrib>Shah, Sandesh</creatorcontrib><creatorcontrib>Helmu, Mangal Bahadur</creatorcontrib><collection>MEDLINE - Academic</collection></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thapa, Santosh</au><au>Raut, Ujwal</au><au>Shrestha, Garima</au><au>Shah, Sandesh</au><au>Helmu, Mangal Bahadur</au><format>book</format><genre>unknown</genre><ristype>RPRT</ristype><atitle>Chorea as the only presenting clinical feature of rheumatic fever: a case report</atitle><jtitle>Annals of medicine and surgery (2012)</jtitle><date>2024-04-01</date><risdate>2024</risdate><volume>86</volume><issue>4</issue><spage>2162</spage><epage>2166</epage><pages>2162-2166</pages><issn>2049-0801</issn><eissn>2049-0801</eissn><abstract>Introduction and importanceSydenham's chorea (SC), a major neurological manifestation of acute rheumatic fever (ARF), is commonly seen in young children and adolescents. It is characterized by rapid, unpredictable, involuntary, and nonpatterned contractions affecting mostly distal limbs. It can also be associated with clinical or subclinical carditis. SC has been reported as a major manifestation in only 3.87% cases of acute rheumatic fever in Nepal.Case presentationThe authors report a case of a 12-year-old boy with abnormal movement of his right hand and unsteady gait for 12 days. On examination, he had an abnormal hand grip with difficulty maintaining a tetanic contraction (Milkmaid's grip). Laboratory investigations revealed increased anti-Streptolysin O titre and erythrocyte sedimentation rate. Echocardiography revealed subclinical carditis. After thorough clinical examination and pertinent investigations, the final diagnosis of ARF with SC was made.Clinical discussionSC is a major clinical feature of rheumatic fever according to the revised Jones criteria. It is related to a previous Group A β-haemolytic Streptococcus pyogenes (GABHS) infection. Approximately 50-65% of the patients with rheumatic fever later develop clinically detectable carditis. Although a self-limiting condition, it might need treatment with antiepileptics, neuroleptics, and phenothiazines.ConclusionAny child presenting with a movement disorder should also be considered for SC, necessitating additional testing, including a cardiovascular assessment. It needs to be distinguished from other causes of movement disorders as well as psychiatric conditions. Treatment is necessary for moderate to severe chorea that interfere with daily activities. Compliance with subsequent antibiotic prophylaxis is essential for avoiding future cardiac complications.</abstract><doi>10.1097/MS9.0000000000001798</doi></addata></record> |
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title | Chorea as the only presenting clinical feature of rheumatic fever: a case report |
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