Already Presented at 14th KONIKA Surabaya, July 2008
CHOREA SYDENHAM, A CLINICAL MANIFESTATION OF ACUTE RHEUMATIC FEVER
Vicka Farah Diba, Noormanto, E.S Herini
Pediatric Health Department, Medical Faculty, Gadjah Mada University
RSUP dr Sardjito, Yogyakarta.
Background : Rheumatic fever is one of the important cause of heart disease in children. It is the main cause of acquired heart disease in Indonesia. Rheumatic fever has many clinical manifestations, i.e., Chorea Sydenham (5-10%), which is rarely recognized so patients got late diagnosis and therapy.
Case : An eight-year old girl came to the doctor with symptom all extremity moved involuntarily. The symptom started since two month before hospitalized. Involuntary movement began in fingers, and then worsen. But it disappeared when she slept. She was got fever and sore throat. She was taken to private hospital in Yogyakarta, and then General hospital in Jakarta, before she came to Sardjito Hospital. She has also often taken to see traditional healer. Physical examination showed involuntary movement in all extremity, inability to speak and to walk. Fast pulse rate, normal 1st and 2nd heart sound, pansystolitic murmur 1-2/6 degree in apex. Electrocardiograph showed sinus tachycardia and 1st degree AV block. Chest X-Ray showed cardiomegaly. Echocardiograph showed mild anterior mitral valve prolapse and severe mitral regurgitation. Laboratory findings showed increased blood sedimentation rate, positive CRP and ASO. Based on modification Jones criteria, she was diagnosed as Acute Rheumatic Fever and treated with penicillin, prednison, aspirin and captopril. One week later, involuntary movement diminished, and she was able to speak normally and walk by herself.
Summary. If we find patient with Chorea Sydenham, remember that it is one of clinical sign of acute rheumatic fever.
Full Article ; Dokter Anakku, Chorea Sydenham