Chorea: rheumatic fever or systemic lupus erythematosus?

Key words: Chorea, Systemic lupus erythematosus, Rheumatic fever

Chorea is a manifestation of inflammatory involvement of the basal ganglia and caudate nucleus of the central nervous system. A patient with chorea presents with persistent involuntary, purposeless, and usually symmetric movements of the extremities and muscular incoordination. Chorea occurs in approximately 5% of paediatric patients with SLE; it is almost universally associated with the presence of antiphospholipid antibody. Chorea is not considered to be one of the neurological criteria in the diagnosis of SLE; it may be a presentation of SLE or appear in course of the disease. In the case presented, a child with chorea was treated with oral penicillin for the risk of rheumatic fever, even though there was neither a history of streptococcal infection nor were the required diagnostic criteria available. Chorea was a first sign of SLE in the child. It is very important to include SLE in differential diagnosis of chorea, to make timely diagnosis and to begin appropriate therapy.