This is the first study comparing adults with a previoushistory of rheumatic fever to comparison subjects that reports a higher frequency of obsessive-compulsive symptoms in non active rheumatic fever patients. The mean age of the rheumatic fever first episode found in our sample was similar to prior studies with children. 2,4 These findings may suggest that rheumatic fever activity is not a necessary condition for the expression of neuropsychiatric symptoms. In acute phase rheumatic fever patients, these manifestations could be the result of an abnormal immune process related to the activity of the disease. In the non acute phase rheumatic fever patients, it cannot be excluded that acute changes might have persisted or might have triggered other psycho-pathological changes that increase the susceptibility to neuropsychiatric disorders. It is well established that carditis continues to evolve even in the absence of rheumatic activity and also that may worsen with reinfections. It is also known that pregnant women with past Sydenham’s chorea are prone to develop chorea gravidarum, even without the recurrence of strep infections.