Investigations
Initial routine laboratory investigations were done. Complete blood
count, renal parameters, liver enzymes and electrolytes were
unremarkable (Table 2). Erythrocyte sedimentation rate was raised, 68
mm/h, Anti-streptolysin O titre = 245 IU/mL. Electrocardiogram: Normal
sinus rhythm (Figure 1). Echocardiography showed mild mitral
regurgitation (Video 1) with normal ejection fraction. Autoimmune panels
and MRI brain not done because of its unavailability in our centre.
A diagnosis of Sydenham chorea was made based on the clinical
probability and was managed with oral Phenoxymethylpenicillin 500 mg
q12h and carbamazepine 200mg twice a day. Choreatic movements reduced,
she was able to carry out her daily activities independently. She was
discharged and currently doing well and is on follow up. She has been
started on secondary prophylaxis with oral Phenoxymethylpenicillin 250
mg twice a day instead of intramuscular injection of Benzathine
penicillin G as preferred by the patient and her parents.