# Sydenham's chorea in a 16‐year‐old female from Bhutan: A case report

## TL;DR

A 16-year-old girl from Bhutan presented with Sydenham's chorea, a rare sign of rheumatic fever, and was found to have subclinical heart disease through echocardiography.

## Contribution

This case highlights the importance of echocardiography in diagnosing subclinical carditis in patients with Sydenham's chorea.

## Key findings

- The patient had subclinical carditis confirmed by 2D Doppler Echocardiography despite no clinical signs of heart disease.
- Treatment with penicillin and Carbamazepine led to full recovery without long-term effects.
- Sydenham's chorea can occur in older adolescents and may be the first sign of rheumatic fever.

## Abstract

Rheumatic heart disease is a preventable disease. Patients may not present with a typical history of sore throat and polyarthritis but may present with Sydenham's chorea. We should not rely completely on clinical findings to rule out carditis. Echocardiography should be done to rule out subclinical carditis.

Sydenham's chorea is a major manifestation of rheumatic fever. It occurs primarily in children and is seen rarely after the age of 20 years. We describe a 16‐year‐old girl who presented with purposeless involuntary movements of her upper and lower limbs. Laboratory blood reports showed raised erythrocyte sedimentation rate and anti‐streptolysin O. 2D Doppler Echocardiography confirmed subclinical carditis, thickened mitral and aortic valve with mild mitral regurgitation. She was managed as Acute Rheumatic Fever with oral Phenoxymethyl penicillin and Carbamazepine. At the latest follow‐up interviewing the caregiver, the patient had no sequelae. Early diagnosis is key to preventing late consequences of acute rheumatic fever and rheumatic heart disease. Sydenham's chorea is a rare presentation of acute rheumatic fever. The absence of clinical carditis does not rule out carditis.