A 9-year-old girl develops rapid, purposeless movements of the hands and face with emotional lability. She had a sore throat 3 months ago. Examination shows milkmaid grip and a pronator sign. ESR and CRP are normal, and echocardiography shows no valvular lesion. Which statement is correct?

• A She does not fulfill Jones criteria because acute phase reactants are normal
• B Aspirin at anti-inflammatory doses is the mainstay of treatment
• C Sydenham chorea alone fulfills the Jones criteria and requires no salicylates or steroids ✓
• D Corticosteroids must be started immediately to prevent carditis

Explanation

Sydenham chorea is a major Jones criterion and can establish the diagnosis by itself, even without raised acute phase reactants or carditis, because it typically appears 1 to 6 months after the streptococcal infection when inflammation markers have normalized. It is self-limiting over weeks to months, so anti-inflammatory therapy is not indicated; severe cases may need carbamazepine or valproate. The distractor about ESR fails because chorea is unique in this regard.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.