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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 19  |  Issue : 2  |  Page : 115-117

Chikungunya presenting with pulmonary involvement – An unusual manifestation


Department of Internal Medicine, Apollo Hospital, Navi Mumbai, Maharashtra, India

Date of Submission02-Feb-2022
Date of Decision12-Feb-2022
Date of Acceptance14-Apr-2022
Date of Web Publication16-May-2022

Correspondence Address:
Sanjay P Khare
X13 Lane No 1, Sector 9, CBD Belapur, Navi Mumbai - 400 614, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_19_22

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  Abstract 


Chikungunya is caused by an arthropod-borne alphavirus transmitted by the mosquito vectors Aedes aegypti and Aedes albopictus.[1] It is being increasingly reported in India in general and Mumbai in particular. The name chikungunya is derived from an African language and means “that which bends up” or “A disease that makes one walk with a stooped gait” because of the incapacitating arthralgia by the disease. The usual presentation is with inflammatory arthritis/polyarthralgia. Systemic manifestations are rare. In this report, we present a case of chikungunya with pulmonary manifestations, which is very unusual. A 69-year-old male patient with laboratory-confirmed reverse transcription-polymerase chain reaction (RT-PCR) chikungunya fever had lung involvement with acute hypoxemia and electrolyte imbalance. Initially, the patient was suspected to have COVID-19 disease as there was a fever with respiratory involvement, and he had presented right in the middle of a COVID-19 pandemic. Bilateral basal crackles and low SpO2 pointed toward the same. However, TruNAAT-COVID (once), rapid antigen test-COVID (once), and RT-PCR for COVID-19 (twice) were negative. Moreover, his upper respiratory tract Multiplex PCR panel was also negative, thereby truncating the possibility of infection with usual/other viruses. Hence, all the clinical features, X-ray, and high-resolution computed tomography of the chest pointed toward pulmonary involvement because of chikungunya, making this a very unusual presentation.

Keywords: Chikungunya, hyponatremia, pulmonary involvement, unusual


How to cite this article:
Khare SP, Yeolkar AV. Chikungunya presenting with pulmonary involvement – An unusual manifestation. Apollo Med 2022;19:115-7

How to cite this URL:
Khare SP, Yeolkar AV. Chikungunya presenting with pulmonary involvement – An unusual manifestation. Apollo Med [serial online] 2022 [cited 2022 Jul 1];19:115-7. Available from: https://www.apollomedicine.org/text.asp?2022/19/2/115/345327




  Introduction Top


This is case of chikungunya (proved by Reverse Transcriptase Polymerase Chain Reaction RT Pcr). There was significant pulmonary involvement (breathlessness, basal crackles and low SpO2) and hyponatremia. All the other possibilities like viral infections and pulmonary embolism were ruled out by relevant tests. Chikungunya is not known to cause pulmonary involvement hence this case is being reported.


  Case Report Top


Patient information

Mr. NS, M/69-known diabetic/HT/BE P. Sugar and BP were under excellent control. He presented with fever and chills for 4 days, polyarthralgia, weakness, Dyspnea on exertion (DOE), hiccups and abdominal pain, nausea, and vomiting.

On examination

He was afebrile, dull, and dehydrated. BP was 130/80, the pulse rate was 84/min, and SpO2 was 92/93%. The random blood sugar level was 220. He had severe polyarthralgia. Knees/shoulders, hips involved. Basal crackles +.

Clinically, this was a textbook picture of chikungunya. However, the respiratory symptoms and signs were unexpected.

Table of Investigations:

His chikungunya diagnosis was secure. All other causative viruses were eliminated.

High-resolution computed tomography of the chest

Multiple patchy areas of ground-glass opacities seen in – both lungs in random distribution.

Patchy consolidation left upper lobe. Plate atelectasis – both lower lobes. Changes appeared infective and probably viral in etiology [Figure 1] and [Table 1].
Figure 1: HRCT Chest

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Table 1: Investigation

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Minimal bilateral pleural effusion with mild cardiomegaly.

Differential diagnosis

  1. Dengue fever
  2. COVID-19
  3. Influenza
  4. Respiratory syncytial virus.


Therapeutic intervention

Intravenous fluids and antipyretics given to the patient. Insulin instead of OHA's. Free fluid curtailed. Extra salt was encouraged. I/O chart. Serial X-rays of the chest were done to compare/track lung involvement. Oxygen 2 L/M. Chest physiotherapy and incentive spirometry.

However, there was a persistent and significant increase in pulmonary features. Crackles increased on auscultation. X-ray chest worsened. Intravenous hydrocortisone was with dose started. 100 mg BD. Immediate improvement – clinically and radiologically seen.



Course

The patient was afebrile with significant improvement in joint pains/range of movements. Crackles reduced and SpO2 improved. Nausea/anorexia/hiccups (ascribed to hyponatremia) reduced significantly. IV steroids converted to oral prednisolone. He was discharged from hospital on day 7.

Outpatient department follow-up

Asymptomatic. Vitals fine. SpO2 was 98% on room air. Arthralgias reduced to 15%. Sugar and BP were normal. Oral steroids tapered off over 5 days.


  Discussion Top


Chikungunya has been of a significant concern for the last decade.[2]

Joint pains may appear even before fever.[3] Features persist for 7–10 days.[4] Swelling/joint effusion is found in 44%–63% of the patients.[5]

Rarely convulsions, meningoencephalitis, hepatitis, renal failure, respiratory failure, and myocarditis can be seen.[6],[7]

Pneumonia/ARDS/Septic shock-rare.[8] Mortality in these occurrences is high.[9]

There may be myriad manifestations that are hitherto unknown to humankind.[10]


  Conclusions Top


Here is a typical case of chikungunya but with significant pulmonary findings. Pulmonary involvement in chikungunya is uncommon and not widely mentioned in the medical literature. Hence, this case was worth reporting.

Informed consent

Informed consent of Mr. NS has been taken.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Simon F, Javelle E, Oliver M, Leparc-Goffart I, Marimoutou C. Chikungunya virus infection. Curr Infect Dis Rep 2011;13:218-28.  Back to cited text no. 1
    
2.
Sankari T, Hoti SL, Govindaraj V, Das PK. Chikungunya and respiratory viral infections. Lancet Infect Dis 2008;8:3-4.  Back to cited text no. 2
    
3.
Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT. Chikungunya: A re-emerging virus. Lancet 2012;379:662-71.  Back to cited text no. 3
    
4.
Staikowsky F, Talarmin F, Grivard P, Souab A, Schuffenecker I, Le Roux K, et al. Prospective study of chikungunya virus acute infection in the Island of La Réunion during the 2005-2006 outbreak. PLoS One 2009;4:e7603.  Back to cited text no. 4
    
5.
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 Réunion. Epidemiol Infect 2009;137:534-41.  Back to cited text no. 5
    
6.
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.  Back to cited text no. 6
    
7.
Lemant J, Boisson V, Winer A, Thibault L, André 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;36:2536-41.  Back to cited text no. 7
    
8.
ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA 2012;307:2526-33.  Back to cited text no. 8
    
9.
Singh A. Acute respiratory distress syndrome: An unusual presentation of chikungunya fever viral infection. J Glob Infect Dis 2017;9:33-4.  Back to cited text no. 9
    
10.
Mohan A, Kiran DH, Manohar IC, Kumar DP. Epidemiology, clinical manifestations, and diagnosis of chikungunya fever: Lessons learned from the re-emerging epidemic. Indian J Dermatol 2010;55:54-63.  Back to cited text no. 10
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