This article presents the case of a 13-year old girl who was admitted to the emergency department because of rapidly evolving, seriously disabling impairments in movement and speech. Investigation led to the conclusion that her problems were caused by Sydenham's chorea as a manifestation of rheumatic fever. A neuropsychiatric examination performed one year after the onset of disease revealed a hitherto unknown mild mental retardation. The case description is followed by a clinical update on rheumatic fever focusing on cerebral manifestations. The theories concerning the existence of PANDAS--an autoimmune neuropsychiatric disorder following streptococcal infections, distinct from rheumatic fever--are presented.

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