Article in Japanese

A case of rheumatic fever with a variety of neuropsychiatric symptoms induced by Sydenhamʼs chorea

Tomohiro HIRADE^1）, Daisuke KOIKE^1）, Fumihide KATO^1）

Rheumatic fever is now a rare disease in Japan. A previously healthy 10-year-old boy was admitted to this hospital with chorea and neuropsychiatric symptoms. The patient had a transient fever and sore throat one month before admission. He had emotional lability and separation anxiety after the fever. Laboratory data revealed that inflammatory markers were elevated on admission; therefore, Sydenhamʼs chorea was suspected. Although typical group A beta-hemolytic streptococcus (GAS) pharyngitis was not identified, a rapid antigen test for GAS was positive. Antibiotics and intravenous immunoglobulin were administered but the neuropsychiatric symptoms did not improve. After commencing steroid pulse therapy, the neuropsychiatric symptoms improved. Even though mitral and aortic regurgitation were identified on echocardiography, there were no clinical cardiac symptoms. Rheumatic fever was diagnosed with two major manifestations: carditis and Sydenhamʼs chorea. Since carditis in rheumatic fever cannot be detected sometimes by only auscultatory findings, echocardiography screening for all patients suspected of having rheumatic fever is recommended. It is important to note that GAS pharyngitis is not always detected typically in patients with Sydenhamʼs chorea because Sydenhamʼs chorea usually appears several months after GAS infection.

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1）Department of Pediatrics, Shimane Prefectural Central Hospital

Key words	Sydenhamʼs chorea, rheumatic fever, Jones criteria, echocardiography
Received	April 2, 2021
Accepted	June 15, 2021

33 (3)：262─269,2021