Three Cs that say everything about rheumatic chorea

Key words: Sydenham's Chorea, Carditis, Corticosteroids, Rheumatic Fever

Although Sydenham’s chorea is an uncommon manifestation of rheumatic fever, it is still the most frequent cause of chorea in children. It is characterized by the sudden appearance of involuntary and disturbing movements of the upper and lower body, associated with grimaces, dysarthria and various psychiatric features. The paper describes two cases of Sydenham’s chorea to portray the clinical heterogeneity of the disease, its association with heart involvement and the efficacy of corticosteroids both in resolving the symptoms and in preventing the relapses, at least when administered in the early stage of the disease. After an introductive description of the disease itself, its epidemiology and clinical features, with reference to our thirty-year experience at Burlo Garofolo, Trieste, is described. The paper also highlights the peculiar traits that paediatricians must remember in order to correctly identify it, especially its close relationship with rheumatic carditis, and the tricks to differentiate it from other conditions that may present with choreic movements. The article also analyses the current treatments available, especially the use of corticosteroids, which has been routinely employed to treat patients, and reports the main positive outcomes.