Chorea, now a less common feature of rheumatic fever, occurs in about five percent of cases. It develops several months after the streptococcal infection and usually occurs without any preceding arthritis or after other disease manifestations have subsided. Chorea is characterized by purposeless, involuntary movements, sometimes associated with emotional lability. In 75 percent of cases, chorea is bilateral. The patient may present with clumsiness or speech slurring.
Choreic movements disappear with sleep.
The disturbance clears without residual disease. Chorea very rarely occurs in adults. The rash is observed in approximately five percent of pediatric patients but is rare in adults. The rash, which is often exacerbated by a warm bath, lasts for only a few hours. Erythema marginatum recurs frequently.