A Case of Initially Undiagnosed Chikungunya Arthritis Developing into Chronic Phase in a Nonendemic Area.

Pui Shan Julia Chan,Moon Ho Leung

doi:10.1155/2017/2592964

Abstract

This case report described a 40-year-old lady presented with fever, headache, arthralgia, myalgia, and impaired liver function after returning from the Philippines. Chikungunya virus (CHIKV) and dengue serology were negative. Eight weeks after initial presentation, she experienced inflammatory polyarthritis mimic rheumatoid arthritis. This time CHIKV-IgM was detected, together with a >4-fold rise of CHIKV-polyvalent-antibody titre. The first CHIKV-IgM negative sample was reexamined and was CHIKV-PCR positive. CHIKV infection was confirmed and diagnosis of CHIKV-related arthritis was made. A quarter of CHIKV infected individuals develop post-CHIKV rheumatisms that affect quality of life and may need treatment with Disease Modifying Antirheumatic Drugs. This case highlights the importance of considering CHIKV infection in patients present with symmetrical polyarthritis particularly after travel to endemic regions. Testing of both CHIKV acute and convalescent-phase serum for CHIKV antibodies and PCR is recommended in suspicious case.

Highlights

We report a case of initial Chikungunya virus (CHIKV)-IgM negative patient, later developed symmetrical polyarthritis resembles rheumatoid arthritis (RA), and CHIKV serology turned positive 8 weeks later
Chikungunya fever is a mosquito-borne disease, endemic to Africa and Southeast Asia, caused by CHIKV, a singlestranded RNA virus that belongs to the family Togaviridae, genus Alphavirus
In the acute phase of infection, high viraemic load with a median duration of viraemia of 6 days and concomitant lymphopenia and/or thrombocytopenia is typical of CHIKV infection [2]

Summary

Introduction

Diagnosis can be challenging as most of the infected individuals present with nonspecific symptoms. We report a case of initial CHIKV-IgM negative patient, later developed symmetrical polyarthritis resembles rheumatoid arthritis (RA), and CHIKV serology turned positive 8 weeks later. Convalescentphase serum should always be obtained from patients whose acute-phase samples test is negative

Case Presentation

Findings

Discussion