RESUMO
A 17-year-old black female developed Sydenham's chorea 8 weeks after inaugurating the daily use of an oral contraceptive. Two weeks after she stopped the oral contraceptive, her signs and symptoms of chorea disappeared. Other causes of chorea were eliminated by various lab tests and a 4-year follow-up on the patient. Phenytoin sodium and methadone are cited as two other medications that have been associated with drug-induced chorea. Some theories are presented about altered dopaminergic sensitivity by various drugs that could produce choreic movements. The literature of chorea associated with oral contraceptives is reviewed. The pediatrician is reminded to consider side effects of oral contraceptives when dealing with a sick teenager.
PIP: This paper reports on the case of a 17-year-old black, healthy girl who developed Sydenham chorea 8 weeks after beginning oral contraception (OC). All laboratory tests being normal, the patient was told to discontinue OC use; 2 weeks later the chorea symptoms disappeared completely and did not return. Chorea is an extremely rare neurological condition associated with OC use; since 1966 there have been only 27 reported cases; in all cases the symptoms disappeared within 1 week-5 months after termination of contraceptive use. It is interesting to note that in 10 out of the 27 reported cases the patients used a preparation containing mestranol. Phenytoin sodium and methadone are cited in the literature as drugs able to induce chorea. Some authors suggest that it is the estrogen component of OC that is responsible for chorea; others suggest an increased dopamine receptor sensitivity. When treating chorea it is important to differentiate drug-induced movement disorders from structural neurologic dysfunctions.
