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THU0285 Deadly Chik: A Report of Two Atypical and Fatal Cases of Chikungunya Fever Complicated by Severe Vasculitis and Renal Failure
  1. G.M. Garcia1,
  2. N. Trinidad2,
  3. R. Destura3
  1. 1Internal Medicine
  2. 2Rheumatology
  3. 3Infectious disease, The Medical City, Pasig City, Philippines

Abstract

Background Chikungunya fever (CHIK) is caused by an alphavirus, Chikungunya virus (CHIKV) of the family Togaviridae, is native to tropical Africa and Asia. Symptoms of chikungunya include sudden onset of fever, severe arthralgia, and maculopapular rash. Chikungunya is generally considered self-limiting and has been reported as non-fatal in the past. However, after the March 2005 outbreak in La Réunion Island, there have been several reports of unusually severe complications and deaths. To date, there have been no published reports of severe atypical and fatal cases of Chikungunya fever in the Philippines.

We thereby present two cases that initially presented with the usual fever, arthropathy and rash of CHIK, but during the course of their hospital stay, their rash worsened into violaceous, vesiculobullous, and vasculitic lesions over the extremities accompanied by edema and oliguria. Rheumatologic workup and bacterial cultures were negative.

Treatment was mainly supportive on admission (NSAIDs, antipyretics). Hydrocortisone was started for arthritis refractory to NSAIDs. Pulse therapy with methylprednisolone was started in the first case once with the appearance of vasculitic lesions, eventually given IVIG infusion as a last resort. They both worsened with the development of acute renal failure and cardiopulmonary collapse necessitating continuous renal replacement therapy, vasopressor and ventilatory support. Despite intensive care, they both succumbed to sudden wide QRS bradyarrhythmias and subsequently died. At post-mortem, RT-PCR was positive for CHIKV Asean genotype 1 for both patients.

Conclusions Although it is generally self-limiting, this report illustrates that CHIK can be a rare cause of vasculitis and acute renal failure. Early identification of features of severe disease with timely aggressive therapy may be prudent especially in the elderly population. Mortality with CHIK may be underreported but it should be noted that the risk of complications increases with age. Since there is no specific treatment for CHIK, prevention through vector control and public health education is key.

References

  1. Sourisseau M, Schilte C, Casartelli N, Trouillet C, Guivel-Benhassine F,Rudnicka D, et al. Characterization of reemerging chikungunya virus.PLoS Pathog. 2007;3:e89.

  2. Bonn, D. How did Chikungunya reach the Indian Ocean. Lancet, September 2006; 6(9): 543.

Disclosure of Interest : None declared

DOI 10.1136/annrheumdis-2014-eular.5328

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