INTRODUCTION
Sydenham chorea represents the most common cause of acquired chorea in childhood [1]. It is one of the major criteria for the diagnosis of acute rheumatic fever [2]. In Sydenham chorea there is both neurological abnormalities and psychiatric disorder. The neurological abnormalities comprise of involuntary choreatic movements, incoordination of voluntary movement, muscular weakness and hypotonia [3]. Psychiatric disorders include emotional lability, hyperactivity, distractibility, obsessions and compulsions [2, 3]. Choreatic movements are involuntary, irregular, purposeless, non-rhythmic, abrupt, rapid and unsustained. It disappears in sleep [2].
The most common age for the onset of acute rheumatic fever is 5 to 15 years old [1]. Rheumatic fever is the major cause of acquired heart disease in children and up to 60% of people who present with Sydenham chorea develops rheumatic heart disease [2]. Rheumatic fever is an acute non-suppurative inflammatory complication of group A streptococcal pharyngitis [4]. Depending on genetic predisposition and the virulence of the infecting strain, 0.3-3% of people with GAS pharyngitis develop ARF [4].
Globally some 30 million people are currently thought to be affected by rheumatic heart disease, and in 2015 rheumatic heart disease was estimated to have been responsible for 305 000 deaths and 11.5 million disability-adjusted life years lost. The worst affected are the African, South-East Asia and the Western Pacific regions, accounting for 84% of all prevalent cases and 80% of all estimated deaths due to rheumatic heart disease in 2015. India has the highest global prevalence, with about 27% of all cases globally [5]. The estimated average prevalence is 0.5/1000 children in age group of 5-15 years [6]. Bhutan, in South-east Asia region, also has a high burden of cases but due to unavailability of data it’s difficult to say how high. In this article, we present a case or Sydenham’s chorea leading to the diagnosis of acute rheumatic fever in a female teenager in Bhutan.