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.