Rheumatic Chorea Without Cardiac Involvement in a 10-Year-Old Girl from a Remote Area: Diagnostic and Management Challenges

Rheumatic Chorea, also known as Sydenham Chorea, is a major neurological manifestation of acute rheumatic fever, an autoimmune complication following infection with Group A β-hemolytic streptococcus (GABHS). It remains common in low- and middle-income countries, where limited healthcare access may delay diagnosis and increase the risk of complications, particulary cardiac. We report a case of a 10-year-old girl from a remote area who presented with involuntary movements, joint pain, and a history of throat infection one month prior to symptom onset. Laboratory tests showed elevated erythrocyte sedimentation rate (ESR) and a positive Anti-streptolysin O (ASO) titer, indicating a recent streptococcal infection. Cardiac examination, including the electrocardiography (ECG), revealed no abnormalities. However, echocardiography, the gold standard for detecting subclinical carditis, was not performed due to lack of available resources. The patient was treated with haloperidol and trihexyphenidyl for chorea, penicillin G benzathine for eradication and prophylaxis of streotococcal infection, and aspirin for its anti-inflammatory effects. Clinical improvement was noted within one month of therapy. This case met the 2015 revised Jones criteria for moderate-risk populations, with major criteria including Sydenham chorea and polyarthralgia, and evidence of recent streptococcal infection (positive ASO). Absence of cardiac involvement may reflect early recognition and treatment, although echocardiography is required to exclude subclinical carditis. Symptomatic therapy and long-term antibiotic prophylaxis are crucial for preventing complications. Rheumatic Chorea can occur without cardiac involvement. Particularly in resource-limited remote areas, early diagnosis, adherence to Jones criteria, and secondary prophylaxis are essential to prevent long-term sequelae.