Sydenham chorea

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Sydenham chorea is a post-streptococcal immune-mediated disorder within the acute rheumatic fever spectrum, caused by autoimmune-mediated dysfunction of basal ganglia circuits following group A Streptococcus infection. It predominantly affects children and adolescents, typically occurring several weeks to months after streptococcal infection.

It can present with psychiatric features such as emotional lability, irritability, anxiety, obsessive-compulsive symptoms, attention difficulties, behavioural change, mood disturbance, and, less commonly, psychosis.

Other characteristic features include neurological manifestations including choreiform movements (involuntary, irregular, purposeless movements), motor impersistence, hypotonia, dysarthria, gait disturbance, and impaired coordination. Distinctive features include a delayed onset following streptococcal infection and the association with other manifestations of acute rheumatic fever, particularly carditis.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Cardiovascular: rheumatic carditis with valvular inflammation (particularly involving the mitral valve), murmurs, and potential progression to chronic rheumatic heart disease may occur.

  • Musculoskeletal: migratory polyarthritis affecting large joints is a characteristic manifestation of acute rheumatic fever and may accompany Sydenham chorea.

  • Dermatologic: erythema marginatum and subcutaneous nodules are characteristic but less common manifestations of acute rheumatic fever.

Early diagnosis is important to enable prompt treatment and secondary prevention of recurrent streptococcal infection, reduce the risk of chronic rheumatic heart disease, address neuropsychiatric symptoms, and improve long-term neurological and functional outcomes.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.