Chorea as the first presenting sign of rheumatic fever in a 12-year-old female child


  • Mitul N. Kasundra Department of Pediatrics, Parul Institute of Medical Science and Research, Vadodara, Gujarat, India



Group a beta hemolytic streptococcus, Rheumatic chorea, Rheumatic fever


Rheumatic chorea (RC*) is a movement disorder seen in young children and adolescents with a recent history of incompletely treated group A beta-hemolytic streptococcal (GABHS) pharyngitis. Although, it rarely presents as the first manifestation of the rheumatic fever, physicians should be aware of the disease, so that early diagnosis and prompt treatment may lead to elimination of the pathogen and prevent further disease progression. We present a case of a 12-year-old female child who presented with only RC as the first clinical sign.


Ilgenfritz S, Dowlatshahi C, Salkind A. Acute rheumatic fever: case report and review for emergency physicians. J Emerg Med. 2013;45:103-6.

Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal disease. Lancet Infect Dis. 2005;5:685-94.

Carapetis JR. Rheumatic heart disease in Asia. Circulation. 2008;118:2748-53.

Roy SB. Prevalence of rheumatic fever and rheumatic heart disease in Ballabhgarh. Annual Report. ICMR. 2012;52:1968-1969.

Mathur KS, Banerji SC, Nigam DK, Prasad R. Rheumatic heart disease and rheumatic fever-prevalence in a village community of Bichpuri Block Agra. J Assoc Physicians India. 1971;19:151-6.

Berry JN. Prevalence survey of chronic rheumatic heart disease and rheumatic fever in Northern India. Br Heart J. 1972;34:134-49.

Indian Council of Medical Research (ICMR) study. Available at: updated on November 2016. Accessed 17 January 2020.

Roy SB. The diagnosis of rheumatic fever J Indian Med Assoc. 1960;35:344-6.

Agarwal BL, Agrawal R. Rheumatic fever. Clinical profile of the initial attack in India. Bull World Health Organ. 1986;64:573-8.

Sanyal SK, Thapar MK, Ahmed SH, Hooja V, Tewari P. The initial attack of acute rheumatic fever during childhood in North India; a prospective study of the clinical profile. Circulation. 1974;49:7-12.

Padmawati S, Arora R. Profile of rheumatic fever and rheumatic heart disease in India. In: Ahuja MMS, editors. Progress in clinical medicine in India. 2 nd series. New Delhi: Arnold Heinemann; 1978:219.

Vaishnava S, Webb JK, Cherian J. Juvenile rheumatism in South India. A clinical study of 166 cases. Indian J Child Health. 1960;9:290-9.

Bland EF, Jones TD. Rheumatic fever and rheumatic heart disease: a twenty-year report on 1000 patients followed since childhood. Circulation. 1951;4:836-43.

Aron AM, Freeman JM, Carter S. The natural history of sydenham's chorea. Review of the literature and long-term evaluation with emphasis on cardiac sequelae. Am J Med. 1965;38:83-95.

Sehar A, Nasir S, Seja A. Rheumatic Chorea as the First Presenting Sign in a 13-year-old Female Child. Cureus. 2019 Aug;11(8).

Chagani HS, Aziz K. Clinical profile of acute rheumatic fever in Pakistan. Cardiol Young. 2003;13:28-35.

Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, et al. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation. 2015 May 19;131(20):1806-18.

Veasy LG. Lessons learned from the resurgence of rheumatic fever in the United States. In: Narula J, Virmani R, Reddy KS, Tandon R, editors. Rheumatic fever. Washington DC: American Registry of pathology. Armed Forces Institute Pathology. 1999:69-78.

Lardhi AA. Sydenham chorea in a 5-year-old Saudi patient. Neurosciences. 2014;19:236-7.

Manjunath C, Vinay HR, Das K, Ghorpade VA. An atypical case of rheumatic chorea in a rural tertiary health center of South India. Int J Contemp Pediatr. 2018;5:1156-8.

Korn-Lubetzki I, Brand A, Steiner I. Recurrence of Sydenham chorea: implications for pathogenesis. Arch Neurol. 2004;61:1261-4.

Regmi PR, Shrestha A, Khanal HH, Nepal BP, Chapagain P. Prevalence of Sydenham’s chorea in patients with acute rheumatic fever in Nepal. NHJ. 2012;9:30-2.






Case Reports