Sydenham’s chorea in Sudan

Background: Sydenham’s chorea (SC), is the most common form of acquired chorea in childhood, it is considered as neurological complication of streptococcal pharyngitis. Our aim was to determine the clinical pattern, association of Sydenham’s chorea with other manifestation of ARF and the laboratory findings of Sydenham’s chorea among Sudanese patients.Methods: This study is descriptive , retrospective cross- sectional study. Fifty patients with different age groups, were diagnosed as having Sydenham’s chorea & followed up at The National center for Neurological sciences, in the period (Jan2017 to Nov2019). Data were obtained after patients consent of by personal interview or personal review of patients records through a designed questionnaire including demographic data, symptoms, co morbid illness, risk factors, physical examination and related investigations.Results: The patients’ median age was 13.7 years: 88% of the cases occurred between 7-17 years with female predominance(35) . Generalized chorea was seen in 33 (66%) and hemichorea 17 (34%) patients. weakness and hypotonia were common, behavior change (44%), dysarthria (71%), gait change(17.20%)and deterioration of handwriting (13%) Arthritis occurred in (36%), carditis 30 (60%), arthritis and carditis in 18(36%), and pure chorea 14 (28%). Erythema marginatum and subcutaneous nodules were not observed in our patients. Only13 patients (26%) gave a history of pharyngitis.Conclusion : There were clear evidence of familial predisposition. Sydenham’ chorea commonly presents acutely in majority of patients. Chorea firstly appeared with oro-fascial movement followed by limb involvement. Minority of patients gave a history of pharyngitis. Brain imaging was normal.

Acute Rheumatic Fever in a COVID-19-Positive Pediatric Patient

Bacterial coinfection and COVID-19 have been reported in pediatric populations. We describe a case of Sydenham’s chorea, which is exceedingly rare in developed countries, with concurrent COVID-19. Discussed here is the clinical course of an 8-year-old COVID-positive female with pure Sydenham’s chorea and subclinical carditis from acute rheumatic fever. To our knowledge, there are no documented reports of acute rheumatic fever in a pediatric patient with coexisting COVID-19 infection.