Chorea and antiphospholipid antibodies: treatment with methotrexate

Chorea may occur in systemic lupus erythematosus (SLE) and primary antiphospholipid antibody syndrome (PAPS). Vascular lesions and immune-mediated excitatory mechanisms have been proposed as the underlying pathophysiology.1,2⇓ Accordingly, immunosuppressive therapy has been employed in antiphospholipid antibody (aPL)-associated chorea.3-5⇓⇓ We report the correlation between clinical symptoms, laboratory activity of aPL, and striatal hypermetabolism in 18F-fluorodeoxyglucose (FDG) PET in a patient with aPL-associated hemichorea. This patient was successfully treated with low-dose methotrexate. A 41-year-old right-handed woman developed involuntary movements of the left hand in June 1999. Within 2 weeks, the symptoms progressed to uncontrollable jerks of the left arm and leg, with clumsiness of finger movements, twitching of the left face with squeezing of the eye, and speech difficulties due to clumsiness of the tongue. She was unable to continue working. Her medical history included …