Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2022

Open Access 01-12-2022 | Joint Pain | Case report

Atypical skin manifestation in severe acute chikungunya infection in a pregnant woman: a case report

Authors: Saovanee Benjamanukul, Jira Chansaenroj, Chintana Chirathaworn, Yong Poovorawan

Published in: Journal of Medical Case Reports | Issue 1/2022

Login to get access

Abstract

Introduction

Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection.

Case presentation

We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered.

Conclusion

Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered.
Literature
1.
Godaert L, Najioullah F, Bartholet S, Colas S, Yactayo S, Cabie A, et al. Atypical clinical presentations of acute phase chikungunya virus infection in older adults. J Am Geriatr Soc. 2017;65(11):2510–5.CrossRef
2.
Rajapakse S, Rodrigo C, Rajapakse A. Atypical manifestations of chikungunya infection. Trans R Soc Trop Med Hyg. 2010;104(2):89–96.CrossRef
3.
Rolle A, Schepers K, Cassadou S, Curlier E, Madeux B, Hermann-Storck C, et al. Severe sepsis and septic shock associated with chikungunya virus infection, Guadeloupe, 2014. Emerg Infect Dis. 2016;22(5):891–4.CrossRef
4.
Torres JR, Leopoldo Codova G, Castro JS, Rodriguez L, Saravia V, Arvelaez J, et al. Chikungunya fever: atypical and lethal cases in the Western hemisphere: a Venezuelan experience. IDCases. 2015;2(1):6–10.CrossRef
5.
Hoz JM, Bayona B, Viloria S, Accini JL, Juan-Vergara HS, Viasus D. Fatal cases of Chikungunya virus infection in Colombia: diagnostic and treatment challenges. J Clin Virol. 2015;69:27–9.CrossRef
6.
Economopoulou A, Dominguez M, Helynck B, Sissoko D, Wichmann O, Quenel P, et al. Atypical Chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005–2006 outbreak on Reunion. Epidemiol Infect. 2009;137(4):534–41.CrossRef
7.
Bonifay T, Prince C, Neyra C, Demar M, Rousset D, Kallel H, et al. Atypical and severe manifestations of chikungunya virus infection in French Guiana: a hospital-based study. PLoS ONE. 2018;13(12):e0207406.CrossRef
8.
Fritel X, Rollot O, Gerardin P, Gauzere BA, Bideault J, Lagarde L, et al. Chikungunya virus infection during pregnancy, Reunion, France, 2006. Emerg Infect Dis. 2010;16(3):418–25.CrossRef
9.
Escobar M, Nieto AJ, Loaiza-Osorio S, Barona JS, Rosso F. Pregnant women hospitalized with chikungunya virus infection, Colombia, 2015. Emerg Infect Dis. 2017;23(11):1777–83.CrossRef
10.
Ritz N, Hufnagel M, Gerardin P. Chikungunya in children. Pediatr Infect Dis J. 2015;34(7):789–91.CrossRef
11.
Caglioti C, Lalle E, Castilletti C, Carletti F, Capobianchi MR, Bordi L. Chikungunya virus infection: an overview. New Microbiol. 2013;36(3):211–27.PubMed
12.
Deeba F, Islam A, Kazim SN, Naqvi IH, Broor S, Ahmed A, et al. Chikungunya virus: recent advances in epidemiology, host pathogen interaction and vaccine strategies. Pathog Dis. 2016;74(3):ftv119.CrossRef
13.
Rahman MM, Been Sayed SJ, Moniruzzaman M, Kabir A, Mallik MU, Hasan MR, et al. Clinical and laboratory characteristics of an acute Chikungunya outbreak in Bangladesh in 2017. Am J Trop Med Hyg. 2019;100(2):405–10.CrossRef
14.
Valamparampil JJ, Chirakkarot S, Letha S, Jayakumar C, Gopinathan KM. Clinical profile of Chikungunya in infants. Indian J Pediatr. 2009;76(2):151–5.CrossRef
15.
Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol. 2008;47(2):154–9.CrossRef
16.
Beserra F, Oliveira GM, Marques TMA, Farias L, Santos JRD, Daher EF, et al. Clinical and laboratory profiles of children with severe chikungunya infection. Rev Soc Bras Med Trop. 2019;52:e20180232.CrossRef
17.
Riyaz N, Riyaz A, Abdul Latheef EN, Anitha PM, Aravindan KP, Nair AS, et al. Cutaneous manifestations of chikungunya during a recent epidemic in Calicut, north Kerala, south India. Indian J Dermatol Venereol Leprol. 2010;76(6):671–6.CrossRef
18.
Fernandes AIV, Souza JR, Silva AR, Cruz S, Castellano LRC. Immunoglobulin therapy in a patient with severe chikungunya fever and vesiculobullous lesions. Front Immunol. 2019;10:1498.CrossRef
19.
Chikungunya: case definitions for acute, atypical and chronic cases. Conclusions of an expert consultation, Managua, Nicaragua, 20–21 May 2015. Releve epidemiologique hebdomadaire. 2015;90(33):410–4.
20.
Crosby L, Perreau C, Madeux B, Cossic J, Armand C, Herrmann-Storke C, et al. Severe manifestations of chikungunya virus in critically ill patients during the 2013–2014 Caribbean outbreak. Int J Infect Dis. 2016;48:78–80.CrossRef
21.
Dotters-Katz SK, Grace MR, Strauss RA, Chescheir N, Kuller JA. Chikungunya fever: obstetric considerations on an emerging virus. Obstet Gynecol Surv. 2015;70(7):453–7.CrossRef
22.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med. 2003;31(4):1250–6.CrossRef
23.
Causes and outcomes of sepsis in southeast Asia: a multinational multicentre cross-sectional study. Lancet Glob Health. 2017;5(2):e157–e67.
24.
Steinberg BE, Goldenberg NM, Lee WL. Do viral infections mimic bacterial sepsis? The role of microvascular permeability: a review of mechanisms and methods. Antivir Res. 2012;93(1):2–15.CrossRef
25.
Lin GL, McGinley JP, Drysdale SB, Pollard AJ. Epidemiology and immune pathogenesis of viral sepsis. Front Immunol. 2018;9:2147.CrossRef
26.
Sebastian MR, Lodha R, Kabra SK. Chikungunya infection in children. Indian J Pediatr. 2009;76(2):185–9.CrossRef
27.
Mor G, Cardenas I. The immune system in pregnancy: a unique complexity. Am J Reprod Immunol. 2010;63(6):425–33.CrossRef
28.
Bonney EA. Immune regulation in pregnancy: a matter of perspective? Obstet Gynecol Clin N Am. 2016;43(4):679–98.CrossRef
29.
Kourtis AP, Read JS, Jamieson DJ. Pregnancy and infection. N Engl J Med. 2014;370(23):2211–8.CrossRef
30.
Silasi M, Cardenas I, Kwon JY, Racicot K, Aldo P, Mor G. Viral infections during pregnancy. Am J Reprod Immunol. 2015;73(3):199–213.CrossRef
31.
Lemant J, Boisson V, Winer A, Thibault L, Andre H, Tixier F, et al. Serious acute chikungunya virus infection requiring intensive care during the Reunion Island outbreak in 2005–2006. Crit Care Med. 2008;36(9):2536–41.CrossRef
32.
Singh A. Acute respiratory distress syndrome: an unusual presentation of chikungunya fever viral infection. J Glob Infect Dis. 2017;9(1):33–4.CrossRef
33.
Kalil AC, Thomas PG. Influenza virus-related critical illness: pathophysiology and epidemiology. Crit Care (Lond, Engl). 2019;23(1):258.CrossRef
Metadata
Title
Atypical skin manifestation in severe acute chikungunya infection in a pregnant woman: a case report
Authors
Saovanee Benjamanukul
Jira Chansaenroj
Chintana Chirathaworn
Yong Poovorawan
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2022
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-021-03197-3

Other articles of this Issue 1/2022

Journal of Medical Case Reports 1/2022 Go to the issue

Case report

Cerebrovascular accident in a child with precursor B-cell acute lymphoblastic leukemia and coronavirus disease 2019: a case report

Case report

Successful treatment of an infant with congenital bile acid synthesis disorder type 3 by ursodeoxycholic acid: a case report

Case report

Necrotizing fasciitis of the vulva due to carbapenem-resistant Enterobacteriaceae as a complication of acute myeloid leukemia treatment: a case report

Case report

Spontaneous regression of breast lymphoproliferative disorders after withdrawal of methotrexate in rheumatoid arthritis patients with Epstein–Barr virus infection: a case report and review of the literature

Case report

Management of primary choroidal lymphoma presenting as extensive serous retinal detachment and salmon patch of bulbar conjunctiva: a case report

Case report

Acquired hemophilia A in the setting of dual anticoagulation therapy and lupus anticoagulant: a case report