Acute rheumatoid arthritis revealed by Sydenham chorea.

Abstract

Introduction : Child's movements disorders are relatively rare. They require careful clinical examination and precise etiological diagnosis to facilitate management and follow-up. We report a case of an inaugural Sydenham chorea of rheumatic fever (RA) in children. Observation : We report 7-year-old boy with a history of poorly treated tonsillitis. He presented 3 days ago an involuntary, permanent, movements disorders proximo-distal predominantly proximal, with axial and peri-oral, bilateral asymmetric predominant right. Blood account showed leukocytes at 11,000 with a CRP at 48mg, a SV at 50 and antistreptolysine antibody at 800IU. The brain MRI was without abnormalities. Cardiac ultrasound was normal. Sydenham chorea diagnosis inaugurating an Acute rheumatoid arthritis was retained. The patient received a corticosteroid therapy : 1mg / kg / day with haloperidol in a progressive dose with a final dose of 0.08mg / day taken and exctencillin at a dosage of 1.2 million units each 15 days. Follow up was marked by a gradual then total disappearance of movements disorders. He was referred to a rheumatologist and pediatrician for coordination and follow-up care. Conclusion : Sydenham's disease is a complication of endemic streptococcal infection. Chorea in children should evoke, look for and treat a rheumatic disease.