An atypical case of Rheumatic Chorea in a rural tertiary health centre of South India

Abstract

Varied presentation of infectious diseases like the rheumatic fever is on the rise especially in rural areas where a great proportion of communicable diseases are undiagnosed and untreated. Keen clinical examination and early treatment with minimal laboratory aid reduce healthcare expenditure in low socioeconomic regions. An 18-year-old adolescent girl presented with acute onset of motor tic for 2 weeks which progressed to vocal tic in a span of 6 weeks. As per the initial presentation, the patient was worked up as a case of Transient Tic Disorder and later as Tourette Syndrome. All the test results including Rheumatic Heart Disease workup were negative. But the patient developed Pure Chorea 2 weeks after this. The patient was treated on a presumptive diagnosis of Rheumatic Chorea and is now in remission for 6 months. Even though tics and other movement disorders can be associated with Rheumatic chorea, it is seldom to present as pure tic disorder at the first encounter and in relatively uncommon age group making this case special. Rather than early referral to movement disorder center, detailed observation of disease progression can prevent unnecessary work up.

Rheumatic Chorea as the First Presenting Sign in a 13-year-old Female Child

“…SC is categorized as a major criterion for acute RF diagnosis. As per modified Jones criteria, clinical appreciation of choreiform movements is sufficient to diagnose RF in the presence of acute infective history [5-6]. Females develop choreiform movements more commonly than males [3].…”

“…In a recent Pakistani prospective study with 60 acute AF children, no case of chorea was appreciated either as the first episode or even as recurrences [7]. There have been other case reports of pediatric RF-both pure as well as with carditis-from other regions including Nepal (13-year-old female) [8], Saudi Arabia (5-year-old male) [4], India (18-year-old female) [5], and the United States (7-year-old female) [9].…”