Case history
Case history
A 10-year-old Samoan girl presents with a 2-day history of fever and sore joints. Further questioning reveals that she had a sore throat 3 weeks ago but did not seek medical help at this time. Her current illness began with fever and a sore and swollen right knee that was very painful. The following day her knee improved but her left elbow became sore and swollen. While in the waiting room her left knee is now also becoming sore and swollen.
Other presentations
Patients, often females, may present with isolated chorea, following a latent period of up to 6 months after the initial group A streptococcal infection. The history may be of a child who becomes fidgety at school, followed by apparent clumsiness along with uncoordinated and erratic movements, often with an associated history of emotional lability and other personality changes. Choreiform movements can affect the whole body, or just one side of the body (hemi-chorea). The head is often involved, with erratic movements of the face that resemble grimaces, grins, and frowns. The tongue, if affected, can resemble a 'bag of worms' when protruded. In severe cases chorea may impair the ability to eat, write legibly, or walk unaided, leading to injury. Chorea disappears with sleep and is made more pronounced by purposeful movements. Recurrence of rheumatic chorea is common, often associated with intercurrent illness, stress, pregnancy, or oral contraception. Rheumatic heart disease is commonly associated with chorea. Mild cases may present with a murmur detected on medical examination; more severe cases may present in cardiac failure. Neuropsychiatric symptoms have also been associated with chorea.[3]
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