Rare Recurrence of Sydenham Chorea in an Adult: A Case Report

Abstract

Background

Sydenham chorea is thought to be an autoimmune condition that usually develops following a group A beta-hemolytic streptococcal infection.The onset of Sydenham chorea in adults is rare and most of the adult cases usually are secondary to recurrence following childhood illness. Risk factors for chorea recurrence include irregular antibiotic prophylactic use, failure to reach remission within 6 months, and symptom persistence for longer than a year.

Case Presentation

A 27-year-old young adult Ethiopian female patient with chronic rheumatic valvular heart disease for the last 8 years experienced repetitive uncontrollable movements of her extremities and torso for three years prior to her current visit. Physical examination was significant for holosystolic murmur at the apical area radiating to the left axilla and choreiform movements apparent on all limbs and trunk. Investigations were significant for mildly raised ESR, echocardiography findings of thickened mitral valve leaflets and severe mitral regurgitation. She was successfully treated with valproic acid and the frequency of penicillin injection was made every 3 weeks with no recurrence for the first 3 months follow-up period.

Conclusion

We believe that this is the first case report of adult onset recurrent Sydenham chorea (SC) from a resource-limited setting. Though Sydenham chorea and its recurrence is rare in adults, it should be considered in adults after ruling out other competing differential diagnoses. Because of the lack of evidence on treatment of such rare cases, individualized mode of therapy is advised. Valproic acid is preferred for symptomatic treatment and more frequent benzathine penicillin G injections, for example every three weeks, may help in the prevention of recurrence of Sydenham chorea.

Keywords:

• Sydenham chorea
• rheumatic fever
• recurrence

Limitations of the Case Report

The first limitation is the short follow-up period of the patient, which is not adequate to trace for any recurrence of Sydenham chorea. The second limitation is the absence of adequate similar case reports to compare and contrast with the current case report.

Ethical Clearance

Ethical clearance including publication of this patient’s case details was obtained from Yekatit 12 Hospital Medical College Review Board.

Consent for Publication

The patient gave a written informed consent for the publication of her case details including the history, physical findings, laboratory reports, and the echocardiography image.

Acknowledgment

We would like to thank all the staff of Yekatit 12 Hospital Medical College and Wudassie Diagnostic Center for their unreserved cooperation in the investigation and management of the patient. We would also like to thank the patient for the written consent she gave for publication of her case details.

Disclosure

We don’t have conflicts of interest in this work.