Tsega Desta Temesgen, Naizgi Mulugeta
Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Ayder Hospital, Mekelle University, Tigray, Ethiopia.
Pediatric Health Med Ther. 2020 Feb 18;11:55-58. doi: 10.2147/PHMT.S229254. eCollection 2020.
Rheumatic fever continues to be a major public health problem in the developing world, being responsible for many morbidities and mortalities. Were it not for its serious effects on the cardiovascular system, and to some extent on the central nervous system, the disease might not have significant consequences. The central nervous system involvement is explained with Sydenham chorea in which case the patient manifests with purposeless and choreiform movements aggravated by stress. Apart from this movement disorder the patient will also demonstrate emotional liability and motor manifestations. It is seen more commonly in children and young adolescent girls. It usually manifests as an isolated phenomenon called pure chorea, without evidence of active rheumatic fever; the other rare form of which is a type of acute rheumatic fever.
This case report is about a nine-year-old female child presenting with two weeks of complaint of abnormal purposeless, non-rhythmic movement of extremities and the face, with failure to communicate. At presentation, she had non-pruritic skin lesions that had appeared a day prior to admission. The skin lesions were circular, red in color, and painless, involving the abdomen, and lower chest anteriorly, and extending to all extremities and the back. Two months previously she had a history of sore throat and treatment with unspecified P.O. medication. Antistreptolysin O (ASO) antibody was 430 Todd units/mL and the erythrocyte sedimentation rate was 58 mm/h. Echocardiography study revealed carditis (no evidence of chronicity) with moderate to severe MR, mild TR, no pulmonary hypertension, good biventricular function, and no pericardial effusion.
In this case report, we would like to show the central nervous system manifestation of rheumatic fever called Sydenham chorea seen together with erythema marginatum and other features of rheumatic fever.
风湿热仍是发展中世界的一个主要公共卫生问题，导致许多发病和死亡情况。若不是其对心血管系统有严重影响，且在一定程度上对中枢神经系统有影响，该疾病可能不会产生重大后果。中枢神经系统受累可通过 Sydenham 舞蹈病来解释，在这种情况下，患者表现为无目的的舞蹈样动作，压力会使其加重。除了这种运动障碍，患者还会表现出情绪易激惹和运动表现。它在儿童和青少年女孩中更常见。它通常表现为一种称为单纯舞蹈病的孤立现象，无活动性风湿热的证据；另一种罕见形式是急性风湿热的一种类型。
本病例报告是关于一名 9 岁女童，她诉说有两周肢体和面部异常无目的、无节律运动，且无法交流。就诊时，她有入院前一天出现的非瘙痒性皮肤病变。皮肤病变呈圆形，红色，无痛，累及腹部、下胸部前方，并延伸至所有四肢和背部。两个月前她有咽痛病史，接受了未指明的口服药物治疗。抗链球菌溶血素 O（ASO）抗体为 430 Todd 单位/毫升，红细胞沉降率为 58 毫米/小时。超声心动图检查显示有心脏炎（无慢性证据），伴有中度至重度二尖瓣反流、轻度三尖瓣反流，无肺动脉高压，双心室功能良好，无心包积液。
在本病例报告中，我们想展示风湿热的中枢神经系统表现，即 Sydenham 舞蹈病，同时伴有边缘性红斑和风湿热的其他特征。
