a Unique Case of Chorea d/t Rheumatic Fever.pptx

Its a clinical case presentation on chorea due to hematic fever especially for pediatric residents

1. Case Presentation By: Dr. Mehboob Yameen Final Year Resident

2. Scenerio A 10 Years old male, 34kg weight, presented in pediatrics emergency of children hospital lahore with complain of difficulty in walking and abnormal body movements from last one month which were sudden in onset unindented and uncontrolable jerky movements of arms, legs and facial muscles. There was history of fever high grade documented as 101 to 102 F gradual in onset, continuous in pattern and relieved by taking oral anti-pyretics. He was vaccinated according to EPI schedule, developmentally normal and product of non-cousin marriage. There was no significant family history. There was no Hx of jaundice, joint swelling, hepato-spleenomegaly, malar rash, oral and nasal ulcers.

3. Clinical Examination Vitally stable Cranial nerves were intact Pupils were Bilaterally equally reactive GCS was 15/15 Tone and Bulk were normal in all four limbs. Power was 4/5 in both upper limbs and 3/5 in both lower limbs. Reflexes were present (2+). Plantars were downgoing bilaterally.

4. Clinical Examination cont. Following Signs were positive Milkmaid sign Darting Tongue Pronator sign Emotional liability

5. Investigations HB 10.1 TLC 7.5 PLT 230 ESR 20 ASO Titer 62 On Echo : Mitral Regurgitation

6. Diagonosis?

7. CHOREA d/t Rheumatic Fever

8. Differential Diagonosis Chorea d/t Rheumatic Fever Chorea d/t SLE Chorea d/t Antiphospholipid Antibody Syndrome Chorea d/t Infections ( Lyme Disease) Chorea d/t Vascular Disease (Stroke)

9. Management Patient was admitted IV line secured. IV Fluids were given. Antibiotics started.(Benzathine pencillin) Tab. Captopril 25mg 3/4th PO BD Tab. Spiromide 20/50mg 3/4th PO BD Tab. Valium Syp. Dosik

10. Outcome Patient was improved, discharged and called for F/O after two weeks. Discharge Medicine: Syp Haloperidol Tab. Valium Tab. Capace Tab. Spiromide Tab. Erythromycin Syp. Duphalac

11. Thank You