Differential Diagnosis
- Single most likely diagnosis
- D) Sydenham chorea: This diagnosis is the most likely due to the patient's symptoms of involuntary, jerky movements (chorea) that are absent during sleep, recent history of sore throat and other symptoms suggestive of a streptococcal infection, and the absence of other neurological deficits. Sydenham chorea is a major criterion for acute rheumatic fever, which can occur after a streptococcal infection.
- Other Likely diagnoses
- A) Conversion disorder: This condition could be considered given the patient's psychological stressors (new school, difficulty making friends) and the presence of involuntary movements that could be psychogenic in origin. However, the specific pattern of movements and their absence during sleep make Sydenham chorea more likely.
- E) Tourette syndrome: Although Tourette syndrome involves involuntary movements, it typically includes vocal tics, which are not mentioned in the scenario. The movements in Tourette syndrome can also be more complex and less likely to interfere significantly with walking and writing at the onset.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B) Hepatolenticular degeneration (Wilson disease): Although less likely due to the acute onset and the patient's age, Wilson disease can cause involuntary movements. Missing this diagnosis could lead to severe neurological deterioration and liver disease if not treated promptly.
- Rare diagnoses
- C) Separation anxiety disorder with school refusal: While the patient's difficulty adjusting to the new school and making friends could suggest a psychological issue, the prominent physical symptoms of involuntary movements make this a less likely primary diagnosis. It could, however, be a contributing factor to the patient's overall presentation.