Atypical neurological manifestations of chikungunya fever: Two case reports

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Date: Apr. 2018
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Clinical report
Length: 1,237 words
Lexile Measure: 1520L

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Byline: Subodh. Mahto, Pulin. Gupta, Akanksha. Singh, Ramesh. Meena

Chikungunya fever (CHIK) is an arboviral disease which is transmitted by a mosquito bite (Aedes aegypti). Fever, polyarthralgia, and maculopapular rash are hallmark clinical manifestations of this disease. These manifestations are self-liming and complete recovery is seen in most of the cases. However, atypical and lethal complications such as myocarditis, hepatitis, Guillain-Barre syndrome (GBS), and meningoencephalitis have been reported in few cases of CHIK. We hereby report two cases of chikungunya infection where rare and atypical manifestations of CHIK, i.e., GBS with bilateral lower motor facial nerve palsy, and meningoencephalitis with epidermal necrosis were seen.

Introduction

Chikungunya fever (CHIK) is a viral disease transmitted by the bite of Aedes aegypti and Aedes albopictus . The causative agent is chikungunya virus (CHIKV), a RNA alpha virus belonging to the Togaviridae family.[1]

Outbreaks of this virus have occurred in India since 2005, and Delhi recently witnessed the outbreaks of CHIK and dengue fever in September 2016, presenting with high-grade fever, rash, arthralgia, and thrombocytopenia.[2] However, atypical presentation and severe complications such as myocarditis, hepatitis, Guillain-Barre syndrome (GBS), and meningoencephalitis can happen rarely.[3]

Case Reports

Case 1

A 36-year-old male, a resident of Delhi, presented to our hospital with complaints of high-grade, continuous fever of 5 days' duration. He also had myalgia and multiple joint pains without signs of inflammation (arthralgia). The patient also complained of rapidly progressing weakness of all the four limbs associated with tingling sensation over the lower limb for the past 2 days and difficulty in breathing since then. On examination, the patient was conscious, oriented with stable vitals, and his single breath count was of 18. Central nervous system (CNS) examination revealed all cranial nerves were normal except bilateral lower motor facial nerve palsy. There was hypotonia in bilateral lower limb, and power in bilateral lower limbs was...

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Gale Document Number: GALE|A535899852