Treat Wilson disease as early as possible with penicillamine and zinc because chelation reverses neurological damage over months, and counsel the patient that transient worsening in the first weeks of treatment is expected and should not prompt discontinuation. In a child with chorea, OCD behaviors, and recent streptococcal infection, Sydenham chorea should be at the top of the differential with ASO titers and antineuronal antibodies ordered immediately.

Initiating this treatment early is absolutely essential for achieving optimal functional outcomes; This presentation strongly supports Sydenham chorea; Core strategy relies on aggressive copper chelation therapy using penicillamine, combined with long-term zinc therapy to block dietary copper absorption; To help confirm it, you should order an antistreptolysin O titer along with other antistreptococcal antibody titers; Its utility is actually quite limited in routine practice, because there is an immense diversity of different mutations scattered across the ATP-seven-B gene