[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-442999-105":59,"doc-detail-442999-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","beyond-the-dance-a-muted-narrative-of-sydenham-chorea","Beyond the dance - A muted narrative of Sydenham chorea","","Sydenham chorea (SC) is a post–acute rheumatic fever neurologic complication that can present beyond classical hyperkinetic motor symptoms. A 14-year-old girl developed 20 days of progressive neuropsychiatric features, including mutism, grimacing, purposeless limb movements, and withdrawal, following a febrile illness. Examination showed choreiform movements; BFCRS scored 9 and improved after a lorazepam challenge to 3, confirming catatonia. Elevated ASO titers and echocardiographic rheumatic heart disease supported ARF with SC. Treatment with benzathine penicillin, lorazepam, sodium valproate, aspirin, and supportive care produced marked improvement within 1 week and complete resolution by follow-up.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/beyond-the-dance-a-muted-narrative-of-sydenham-chorea/442999/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/beyond-the-dance-a-muted-narrative-of-sydenham-chorea/442999.png","ImageObject",300,407,{"name":92,"@type":93},"dabgoudw","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is Sydenham chorea (SC) and when does it typically occur?","Question",{"text":112,"@type":113},"Sydenham chorea is a recognized neurological complication of acute rheumatic fever, typically appearing 4–8 weeks after a Group A beta-hemolytic streptococcal infection.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How was catatonia identified in this case?",{"text":117,"@type":113},"Bush-Francis Catatonia Rating Scale (BFCRS) scored 9 with key findings such as mutism, stereotypy, and withdrawal; a lorazepam challenge reduced the score to 3, confirming catatonia.",{"name":119,"@type":110,"acceptedAnswer":120},"Which treatments led to improvement and what was the outcome?",{"text":121,"@type":113},"The patient received intramuscular benzathine penicillin, intravenous lorazepam, sodium valproate, aspirin, and supportive care, with remarkable improvement within 1 week and complete resolution of motor and behavioral symptoms at follow-up.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442999,1790765666,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985747860484,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","LETTERS TO EDITOR  \nBeyond the dance: A muted narrative of Sydenham chorea  \nDear Editor  \nSydenham chorea (SC), historically termed St. Vitus dance, is a recognized neurological complication of acute rheumatic fever (ARF) and one of the major Jones criteria.[1] It typically arises 4–8 weeks after a Group A beta-hemolytic streptococcal (GABHS) infection. SC is a hyperkinetic disorder characterized by irregular, jerky movements affecting the face, limbs and trunk, associated with emotional lability, and hypotonia.[2] Beyond the classical motor symptoms, recent research highlights a broader neuropsychiatric profile that includes anxiety, irritability, emotional lability, obsessive-compulsive symptoms, and in rare instances, catatonia.[3] This case report underscores the importance of recognizing such atypical neuropsychiatric presentations.  \nA 14-year-old girl from an urban, lower socioeconomic background presented with 20 days of progressive neuropsychiatric symptoms. These included mutism, grimacing, purposeless limb movements, and behavioral withdrawal. Prior to symptom onset, she experienced a febrile illness with vomiting but no respiratory signs. Over subsequent weeks, her ability to communicate and perform daily activities deteriorated, eventually becoming mute, irritable, and bedridden.  \nExamination revealed choreiform movements involving her limbs and face. Bush-Francis Catatonia Rating Scale (BFCRS) showed a score of 9, with significant findings including mutism, stereotypy, and withdrawal. A lorazepam challenge reduced her score to 3, confirming catatonia. Elevated antistreptolysin O (ASO) titers (297.32 IU/mL), mitral area pansystolic murmur, and echocardiographic findings of rheumatic heart disease with moderate mitral regurgitation supported a diagnosis of ARF with SC.  \nThe patient was managed with intramuscular benzathine penicillin, intravenous lorazepam, sodium valproate, aspirin, and supportive care. Remarkable clinical improvement was noted within 1 week, with complete resolution of motor, and behavioral symptoms at follow-up.  \nThis case exemplifies a rare and diagnostically challenging co-occurrenceofSCandcatatonia.WhileSCiswell-recognized as a post-streptococcal autoimmune disorder involving the basal ganglia, catatonia as a neuropsychiatric sequel remains underreported. [4] Autoimmune dysfunction affecting cortico-striato-thalamo-cortical circuits may underlie such presentations, drawing parallels with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and NMDAR encephalitis. [4,5] The  \npositive lorazepam challenge further reinforces a GABAergic dysfunction possibly triggered by autoantibodies.  \nThis case highlights the importance of screening for catatoniain pediatric patients with abrupt behavioral changes, especially those with a recent history of streptococcal illness. Diagnostic tools like BFCRS and therapeutic trials with benzodiazepines are valuable in such contexts.  \nSC, though primarily a motor disorder, can present with rare neuropsychiatric features such as catatonia. Early recognition and targeted treatment can result in complete recovery. Clinicians must maintain a high index of suspicion for catatonia in pediatric neuropsychiatric cases to avoid misdiagnosis and delay in effective intervention.  \nDeclaration of patient consent  \nThe authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.  \nFinancial support and sponsorship  \nNil.  \nConflicts of interest  \nThere are no conflicts of interest.  \nRiya Gangwal, Rahul Mathur, Prashant Gaurav  \nDepartment of Psychiatry, MGM Medical College, Indore, Madhya Prade","cbCaiqMkJ3Dni126","https://ap.wps.com/l/cbCaiqMkJ3Dni126","pdf",309143,"English","# Case presentation and clinical course\n## Neuropsychiatric features and examination\n## Catatonia confirmation with BFCRS and lorazepam challenge\n# Investigations supporting ARF with SC\n## ASO titers and cardiac findings\n# Management and outcome\n## Treatments administered and response\n# Discussion and clinical implications\n## Screening and diagnostic considerations","[{\"question\":\"What is Sydenham chorea (SC) and when does it typically occur?\",\"answer\":\"Sydenham chorea is a recognized neurological complication of acute rheumatic fever, typically appearing 4–8 weeks after a Group A beta-hemolytic streptococcal infection.\"},{\"question\":\"How was catatonia identified in this case?\",\"answer\":\"Bush-Francis Catatonia Rating Scale (BFCRS) scored 9 with key findings such as mutism, stereotypy, and withdrawal; a lorazepam challenge reduced the score to 3, confirming catatonia.\"},{\"question\":\"Which treatments led to improvement and what was the outcome?\",\"answer\":\"The patient received intramuscular benzathine penicillin, intravenous lorazepam, sodium valproate, aspirin, and supportive care, with remarkable improvement within 1 week and complete resolution of motor and behavioral symptoms at follow-up.\"}]","Beyond the dance - A muted narrative of Sydenham chorea | PDF",1790702508]