An Unusual And Intriguing Presentation Of Sydenham’s Chorea

A 26-year-old male born of a non-consanguineous marriage with normal birth and developmental history presented with abnormal movements for the last 15 years. He first noticed changes in his handwriting. The movements were jerky, non-stereotyped, and were associated with violent flinging movements. They were not preceded by any premonitory urge and were only partially suppressible. The movements gradually progressed to involve the face and neck, and, over the next 5 years, became generalized. His parents also complained of behavioral disturbances such as hyperactivity, aggressiveness, and obsessive-compulsive behavior. There was no history of cognitive decline, psychosis, seizures, or myoclonic jerks. Family history was non-contributory. There was no history of rheumatic fever, vasculitis, or exposure to toxins. The patient suffered frequent throat infections until the age of 5 years. He had been previously prescribed multiple medications, without significant improvement (tetrabenazine, haloperidol, valproate, clonazepam in various combinations). This letter shows an unusual presentation of Sydenham’s chorea lasting more than 15 years and highlight the utility of antineuronal antibodies in such a scenario