Abstract
BackgroundChikungunya fever is an emerging arboviral disease characterized by an algo-eruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years. Up to now, the pathophysiology of the chronic stage is poorly understood.Case presentationWe report the first case of CHIKV infection with chronic associated rheumatism in a patient who developed progressive erosive arthritis with expression of inflammatory mediators and persistence of specific IgM antibodies over 24 months following infection.ConclusionsUnderstanding the specific features of chikungunya virus as well as how the virus interacts with its host are essential for the prevention, treatment or cure of chikungunya disease.
Highlights
Chikungunya fever is an emerging arboviral disease characterized by an algoeruptive syndrome, inflammatory polyarthralgias, or tenosynovitis that can last for months to years
We report the case of a patient with Chikungunya virus (CHIKV) infection presenting with severe chronic rheumatism accompanied by progressive destruc
Chikungunya virus infection is usually a self-limiting disease characterized by arthralgia with late peripheral joint pain in the smaller joints [11,12]
Summary
Chikungunya virus (CHIKV) is an enveloped positivestrand RNA alphavirus which can infect human epithelial and endothelial cells, fibroblasts or macrophages [1,2]. The patient had persisting inflammatory arthralgia and joint stiffness which were not improved by symptomatic treatment One year later, he developed refractory tenosynovitis in the wrists. Methotrexate (MTX) was initiated at the dose of 17.5 mg/week and four months later, dramatic improvement was observed in both the number and state of swollen and tender joints and in tendon involvement At this time, MRI of the hands, wrists and feet showed reduced progression of erosion and a decrease in radiographic inflammation and oedematous damage compared to before treatment. Four months following initiation of treatment, the expression of most of the above mRNAs was attenuated, and expression of CD40L, IFN-α and IL-22 remained undetectable At this time, cytokine levels measured in the cell culture supernatant were markedly decreased and surface CD40L expression on peripheral blood cells could not be detected (data not shown)
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