Diagnostic Dilemma


A 10 years old boy presented with purposeless involuntary movements of right side of body for past 2 days which disappeared in sleep and accompanied by emotional liability. There is no fever, jaundice, drug ingestion or any other illness in past. On examination he has bilateral choreoathetosis {right side more than the left} with positive milk maid’s sign, Jack in the box sign and pronator sign. Other systems are normal.

How to approach this case_?
Expert Opinion :
Thanks for wonderful answers. Apart from rheumatic chorea, we will have to rule out wilson’s disease, hemosiderosis, HIV, basal ganglia calcifications, infarct, moya moya disease, Huntington’s chorea. We need to do an MRI brain, ASLO, HIV, and 24 hours urine for copper.
Answer Discussion :
Shivani Randev
Seems to be Rheumatic chorea. Essential criteria may not be found but investigate for other major and minor criteria. Treatment is haloreidol.
11 years ago
Radha Kumar
Rheumatic chorea
12 years ago

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