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Chikungunya Arthritis in a Rheumatology Clinic in New York City

This case appears in the HSS publication Grand Rounds from HSS - Management of Complex Cases, Fall 2014 - Volume 5, Issue 2, Case 3

Chikungunya is an RNA arbovirus and is included among the arthritogenic alphaviruses. The Tanzanian word Chikungunya means “to walk bent over,” and refers to the incapacitating joint pain experienced by patients with this infection. Since 2006, the US had an average of 28 imported cases per year from endemic areas. However, both mosquito vectors, A. albopictus and A. aegypti, are now found in the US. Local transmission of the virus was reported in Florida in July 2014. There is no effective antiviral therapy; treatment is symptomatic and supportive with NSAIDs and corticosteroids. This featured case, presented by Susan M. Goodman, MD, and Karima Becetti, MD includes 2 case reports:

Case Report 1:
A 59-year-old woman with systemic lupus erythematosus (SLE) presented with joint pain and fever after visiting Puerto Rico. A lupus flare was suspected, but she failed to improve with corticosteroids. Testing revealed positive Chikungunya titers; IgM 1:640 and IgG 1:20. Three months later the patient continued to have joint pains despite therapy with naproxen, prednisone and hydroxychloroquine.

Case Report 2:
A 47-year-old healthy woman presented with severe joint pain of 1 month's duration. The patient first developed fever, a diffuse erythematous rash (Figure 1), joint pain and swelling of her hands and feet during a visit to the Dominican Republic. There was involvement of multiple large and small joints in a symmetrical pattern with 2-3 hours of morning stiffness. Chikungunya titers were positive; IgM 1:1280 and IgG 1:2560. The patient was unable to tolerate high dose NSAIDs, so prednisone 10mg daily was initiated for symptom control. Symptoms persisted 3 months after diagnosis.

Read full case details in Volume 5, Issue 2 of Grand Rounds - Complex Cases.

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Questions or Comments?

For any questions or comments regarding GRMCC, email complexcases@hss.edu.