An 11-year-old boy presented with orofacial pain and involuntary movements. Elevated ASO titer and echocardiography showing mitral insufficiency led to the diagnosis of rheumatic fever with Sydenham’s chorea and subclinical carditis. Treatment with steroids and antibiotics improved symptoms rapidly. This case highlights the need to consider rheumatic fever in movement disorders and the key role of echocardiography in suspected chorea.