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 upper and lower limbs. Laboratory blood reports showed raised Erythrocyte Sedimentation Rate and Anti-streptolysin O. 2D Doppler Echocardiography confirmed sub-clinical carditis, thickened mitral and aortic valve with mild mitral regurgitation. She was managed as Acute Rheumatic Fever with oral Phenoxymethyl penicillin and carbamazepine.

Early diagnosis is a key to prevent the late consequences of Acute Rheumatic Fever and Rheumatic Heart Disease.

Sydenham’s chorea is a rare presentation of Acute Rheumatic Fever. Absence of clinical carditis does not rule out carditis. Echocardiography should be done.