Missed Sydenham's Chorea / Rheumatic Fever?

[worriedmommy]

How would I determine if dd's symptoms may actually be missed Sydenham's Chorea? Dd, age 5, had strep last September, and subsequently had presumed H1N1 at the end of October, and about 2 weeks later had an unexplained high fever for 5 days. Right after that she developed a tic cough that went away twice on abx. Then Feb 7, 2010 she had an explosion of motor & vocal tics (during a time where there were 11 cases of strep throat in her classroom --she was swabbed, but results were negative). Her tics included throat clearing, facial grimacing, neck extensions, abdominal jerks, leg movements, and small knee bends. In conjunction with the tics, she was extremely emotional, and was literally unable to sit still.

 

We just had a doctor's appt on 4/2/10 with a GI doc, and the doctor mentioned that he could hear a murmur (which she's had for a couple of years) and an irregular heartbeat (which is a NEW development). I took her to her pediatrician last week so he could listen to her heart and he also heard the irregular beat. He wasn't overly concerned...but I'm worried. Given everything else that has gone one, could this irregular beat be a result of missed ARF, and perhaps her movements were Sydenham's Chorea?

 

Anyone out there familiar with Sydenham's Chorea or ARF? I've seen a couple Sydenham's Chorea clips on You Tube, and dd's movements weren't so "dance-like". Hers are definitely more jerkey.

[Joan Pandas Mom]

I was wondering the same with my son. Two Neuro's thought it could be possible. Two Pedi's thought it wasn't. I am going to go ahead with the ECHO anyway to make sure his heart is OK.

 

How would I determine if dd's symptoms may actually be missed Sydenham's Chorea? Dd, age 5, had strep last September, and subsequently had presumed H1N1 at the end of October, and about 2 weeks later had an unexplained high fever for 5 days. Right after that she developed a tic cough that went away twice on abx. Then Feb 7, 2010 she had an explosion of motor & vocal tics (during a time where there were 11 cases of strep throat in her classroom --she was swabbed, but results were negative). Her tics included throat clearing, facial grimacing, neck extensions, abdominal jerks, leg movements, and small knee bends. In conjunction with the tics, she was extremely emotional, and was literally unable to sit still.

 

We just had a doctor's appt on 4/2/10 with a GI doc, and the doctor mentioned that he could hear a murmur (which she's had for a couple of years) and an irregular heartbeat (which is a NEW development). I took her to her pediatrician last week so he could listen to her heart and he also heard the irregular beat. He wasn't overly concerned...but I'm worried. Given everything else that has gone one, could this irregular beat be a result of missed ARF, and perhaps her movements were Sydenham's Chorea?

 

Anyone out there familiar with Sydenham's Chorea or ARF? I've seen a couple Sydenham's Chorea clips on You Tube, and dd's movements weren't so "dance-like". Hers are definitely more jerkey.

[sf_mom]

I am very familiar with Kawasaki's and Rheumatic Fever.

 

In a little bit of hurry this morning but wanted to give you attached link.

 

http://en.diagnosispro.com/disease_compari...5643-19125.html

[Suzan]

My dd7 developed an irregular heartbeat (PVC) several years ago. She's been monitored by a heart specialist since then. She's had the full heart workup and they are not concerned, they just monitor it to ensure everything is still OK. He said tons of people have PVC's and they don't even know it (we found out because she was in the hospital getting surgery on her hemangioma birthmark).

 

But, considering that you have the murmur and now irregular hb, I would take her to a cardiologist for a full workup to ensure everything is OK with her heart. I don't have any info about the other, SC or RF, I still wonder about that for my dd7 too.

 

Susan

[lyme_mom]

How would I determine if dd's symptoms may actually be missed Sydenham's Chorea? Dd, age 5, had strep last September, and subsequently had presumed H1N1 at the end of October, and about 2 weeks later had an unexplained high fever for 5 days. Right after that she developed a tic cough that went away twice on abx. Then Feb 7, 2010 she had an explosion of motor & vocal tics (during a time where there were 11 cases of strep throat in her classroom --she was swabbed, but results were negative). Her tics included throat clearing, facial grimacing, neck extensions, abdominal jerks, leg movements, and small knee bends. In conjunction with the tics, she was extremely emotional, and was literally unable to sit still.

 

We just had a doctor's appt on 4/2/10 with a GI doc, and the doctor mentioned that he could hear a murmur (which she's had for a couple of years) and an irregular heartbeat (which is a NEW development). I took her to her pediatrician last week so he could listen to her heart and he also heard the irregular beat. He wasn't overly concerned...but I'm worried. Given everything else that has gone one, could this irregular beat be a result of missed ARF, and perhaps her movements were Sydenham's Chorea?

 

Anyone out there familiar with Sydenham's Chorea or ARF? I've seen a couple Sydenham's Chorea clips on You Tube, and dd's movements weren't so "dance-like". Hers are definitely more jerkey.

Lyme is a possibility and it is much more common. Have you had your child evaluated by a lyme-literate specialist or tested by Igenex? Those symptoms you mentioned could be lyme. It often begins with an unexplained fever and tics, leg jerks, emotional lability and an irregular heartbeat can be symptoms.

[tpotter]

Could be, and I would definitely ask for a cardiac consult and/or rheumatologist (we did both). Doesn't hurt to make certain. But, keep in mind, too that some of our kids have Sydenham's Chorea (including mine), and it is with the dx of PANDAS (see Madeleine Cunningham's work.) We did r/o ARF, though, before determining that it was "just" PANDAS.

[sf_mom]

Here is some information on Syndenham Chorea:

 

http://www.ninds.nih.gov/disorders/sydenham/sydenham.htm

 

http://www.movementdisorders.org/UserFiles/file/chorea.pdf

 

Extended high fever could also be consistent with Kawasaki's. Do you remember how her symptoms developed. Did she have what looked like 'pink eye' in both eyes prior to fever? Did she have any mouth sores around that time? Chapped or red lips? Red eyes? With Kawasaki's you will NOT have positive throat cultures or raised ASO or Anti-DNAse-B titers. BUT, it very similar to ARF and symptoms are often delayed in their presentation.

 

In our situation, all our children were exposed to child with ARF and another child with active strep..... two of our children got sick shortly thereafter and it started with what looked like pink eye in both eye, then followed by a high fever a few days later. First TIC did not set in until 6 months later.

 

-Wendy

[worriedmommy]

Here is some information on Syndenham Chorea:

 

http://www.ninds.nih.gov/disorders/sydenham/sydenham.htm

 

http://www.movementdisorders.org/UserFiles/file/chorea.pdf

 

Extended high fever could also be consistent with Kawasaki's. Do you remember how her symptoms developed. Did she have what looked like 'pink eye' in both eyes prior to fever? Did she have any mouth sores around that time? Chapped or red lips? Red eyes? With Kawasaki's you will NOT have positive throat cultures or raised ASO or Anti-DNAse-B titers. BUT, it very similar to ARF and symptoms are often delayed in their presentation.

 

In our situation, all our children were exposed to child with ARF and another child with active strep..... two of our children got sick shortly thereafter and it started with what looked like pink eye in both eye, then followed by a high fever a few days later. First TIC did not set in until 6 months later.

 

-Wendy

 

She actually had 2 cases of 5 day high (103 F) fevers last year. One in May and one in Nov.

 

The one in May occurred right after the onset of severe seasonal allergies...so her eyes were an absolute mess. Her eyballs actually swelled to the point that one had bleeding within it, and she had that the white of her eyeball had a bloody patch for almost a month. So red eyes were there, and they were runny, but allergies were thought to be the cause. At the time she had peri-anal strep, which went undiagnosed for 2 months. (We've since "fired" that pediatrician who felt it was more likely that dd was just "exploring" herself down there than it was that she had peri-anal strep. Ugh!) No mouth sores or chapped lips.

 

The high fever in November came 8 days after she had presumed H1N1. I don't recall mouth sores or chapped lips then either, but do know that she had what we thought was pink eye sometime in the fall. I honestly can't remember if it was before or after the fever though. Can't even check medical records b/c I had left over pink eye medication that I used on her so I never took her to the doctor.

[sf_mom]

Talk to your current Dr. about symptoms in MAY and potential misdiagnoses. DO YOU HAVE ANY LAB WORK FROM THAT TIME? I would have an Ecco done to see if there is any heart involvement.... If she has been on antibiotics aneurysm sometimes do resolve but not always. Our son's took about 6 months but he also had IVIG on day 5 of high fever. The red eyes at the time of fever in May are concerning. This is what my son's eyes looked like post IVIG. They were much, much worse pre IVIG.

 

http://www.aao.org/eyecare/conditions/uvei...ges/uveitis.jpg

 

Did you ever notice peeling around finger tips or toes... peeling skin on palms or soles of feet? Where her lips ever appear swollen or darker red? Did she ever have any rashes any where around these illnesses?

 

-Wendy

Edited April 13, 2010 by SF Mom