Introduction: Sydenham's chorea is permanently on the rise in developing countries and may suddenly reappear in developed nations.
Patients and methods: We studied a prospective series of 55 cases, involving a total of 89 outbreaks with long-term follow-ups. All the cases were considered to be rheumatic from the outset, whether they were pure choreas or accompanied by the other signs from the Jones criterion, 38 and 17 respectively, in the first outbreak. Ages ranged between 7 and 22 years, with a mean of 15, at the time of the first outbreak; there was a predominance of females (87%).
Results: Hemichorea accounted for 54% of cases. Presentation under treatment was mild (60%), moderate (27%) and severe (13%). Duration ranged from 30 to 365 days. Most of the patients presented just one outbreak and only 18% had multiple outbreaks, between 2 and 10 in number. Ballism was observed in five patients, a state of chorea in two of them, another two had chorea mollis and corea gravidarum was found in five of the patients. Chorea was associated to hypotonia, incoordination, fatigue, postural disorders, motor impersistence, dysarthria and altered gait. Psychiatric disorders were frequent and varied, the most predominant being anguish, irritability, psychomotor restlessness, obsessive-compulsive traits and insomnia. The only important sequela involved the heart, with 10 cases, two of which required surgery.
Conclusions: Crystalline penicillin was used to eradicate streptococcus, neuroleptic agents were employed to reduce involuntary movements and psychiatric symptoms, and benzathine was utilised as a prophylaxis for relapses and sequelae.