ACUTE rheumatic fever is well recognized as a cause of inflammation of the endocardium, the pericardial and pleural cavities, the joints and, occasionally, the lungs. In the brain, Sydenham's chorea is accepted as a rheumatic equivalent and a frequent cause of valvular lesions of the heart.1 It is also fairly well known that Sydenham's chorea may account for a great variety of behavior disorders in children.2 However, it is not so well known that acute rheumatic fever may produce severe mental changes of a different character and without the motor phenomena typical of Sydenham's chorea. It is this group with which our report is concerned. In some of these patients the disturbance is bizarre, with vague hallucinations, phobias and acute panic-like episodes. Delirium, with increased psychomotor activity, restlessness, twitching of the muscles and even convulsions may appear. In some cases the cataleptic features may be prominent, so that
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