Solving a Neurologic Mystery: Recognizing Rheumatic Fever in the Pediatric Patient
HISTORY OF PRESENT ILLNESS The mother reported that her child has been fatigued during the past month and sleeping more than usual. The child had been healthy until about two weeks ago when the mother noticed uncontrollable twitching, mood swings, and agitation. The uncontrollable body movements became progressively worse and were more prominent on the left side. Two days ago the child s speech became slurred and it sounded as though ‘‘her tongue was too big for her mouth.’’ The child was seen in an emergency department, and her laboratory tests and head computed tomography scan were normal. She was diagnosed as having a psychiatric disorder and released with instructions to follow up with her primary care provider, with no referral for a psychiatric evaluation. Today she began having left-sided weakness as well as unsteadiness on her feet.