An eight-year-old girl presented to the emergency department with the onset of involuntary movements in her arms, legs and face for four days. The movements began in her legs and progressed to her arms and face on the same day. She also had a runny nose, mild arthralgia and odynophagia during the week. She had a sore throat followed by upper airway disease and pharyngitis twice in the past two months and had received antibiotics for its treatment. She had no other history of similar disease, trauma, neck stiffness or loss of consciousness.
During her examination, she had slurred speech, generalised hypotonia and hypertrophic tonsils without inflammation. Her anti-deoxyribonuclease B titre was 2100 IU/mL, and antistreptolysin O titre was 1139 IU/mL, indicating a streptococcus group A infection recently. She was diagnosed with acute rheumatic fever with SC.
Her initial treatment was with amoxicillin and valproic acid, but there was no improvement. On the fifth day, intravenous immunoglobulins (IVIG) were initiated. Her discharge was one week later. She was prescribed oral haloperidol for 10 days and intramuscular penicillin G benzathine injection every three weeks.
She was also advised speech therapy and physiotherapy. Her follow-up one month later showed significant improvement.
Name of contributor:
Asim Ali, Gibson O Anugwom, Usama Rehman, Muhammad Zain Khalid, and Mohammad Omar Saeeduddin
SC may range from mild jerky movements to impairment that may even last years. In a study by Regmi et al., isolated SC in acute rheumatic fever was reported in only 0.6% of patients, making this a unique case. The treatment course for SC is not defined since the study population data is minimal. Haloperidol and antiepileptics, such as carbamazepine and valproic acid are used. IVIG is also used since neuronal antibodies cause SC.