Case presentation A 16-year-old boy is referred to the medical team with abnormal involuntary facial movements. He was well until eight weeks before admission when he developed a sore throat and febrile illness associated with pain and swelling in several large joints. The symptoms began in his knees, before moving to his ankles and finally his elbows, and responded partially to ibuprofen. However, he made a full recovery within three weeks. For the last 24 hours, his parents noticed emotional lability and involuntary rapid and purposeless movements, particularly in his face. He denies weakness or sensory loss.
Examination This adolescent is not febrile. He has brief uncoordinated facial movements consistent with chorea. His skin, nails, and mucosal surfaces are normal. Cardiovascular examination reveals a friction rub and pansystolic murmur in the mitral area. Respiratory and abdominal…
