Chikungunya and dengue virus antibodies in a traveller with severe arthralgia returning from India

Abstract

Case presentationA 42-year-old Caucasian woman presented to a travel clinic inGermany with sore throat, fatigue, myalgia, and severe arthralgiaof the hands, elbows, shoulders, hips, knees, and feet. Swellingsof the hands and feet had developed (Fig. 1) and the patientwas barely able to walk upright. She had returned 1 day beforefrom a 2-week stay in Bangalore, India, where she had workedas a teacher. Headache and fever had been the first symptoms11 days before, which had been followed by myalgia, joint painand a rash 1 and 2 days later, respectively. The maculo-papularrash had initially covered the legs, and later the trunk and arms.By the time of presentation to the travel clinic the rash was nolonger visible, and headache and fever had disappeared (Fig. 2).There was unilateral submandibular lymphadenopathy, and thethroat looked slightly inflamed. C-reactive protein (CRP) level was0.70mg/dl (normal level <0.5mg/dl), lactate dehydrogenase levelwas 293U/l (normal <248U/l). Full blood count showed a normal