Investigations
Initial routine laboratory investigations were done. Complete blood count, renal parameters, liver enzymes and electrolytes were unremarkable (Table 2). Erythrocyte sedimentation rate was raised, 68 mm/h, Anti-streptolysin O titre = 245 IU/mL. Electrocardiogram: Normal sinus rhythm (Figure 1). Echocardiography showed mild mitral regurgitation (Video 1) with normal ejection fraction. Autoimmune panels and MRI brain not done because of its unavailability in our centre.
A diagnosis of Sydenham chorea was made based on the clinical probability and was managed with oral Phenoxymethylpenicillin 500 mg q12h and carbamazepine 200mg twice a day. Choreatic movements reduced, she was able to carry out her daily activities independently. She was discharged and currently doing well and is on follow up. She has been started on secondary prophylaxis with oral Phenoxymethylpenicillin 250 mg twice a day instead of intramuscular injection of Benzathine penicillin G as preferred by the patient and her parents.