https://meditropics.com/pdc-2024-1-answer/

^{*Sharique Imbesat}

^{*PG Resident, Department of Medicine , LHMC}

Case presentation:

A 38 year old female presented with undifferentiated fever to Medicine OPD. She developed joint pain after resolution of symptoms on day 12 of illness. Lab findings included anemia (10gm/dL) and thrombocytopenia (1.02L/mm³).IgM Chikungunya ,IgM dengue and Peripheral smear were negative for malarial parasite. The patient developed pigmentation over nasal bridge and facial region on day 15 of illness. The arrow in the figure depicts these skin changes. These findings are consistent with Chik sign seen typically in Chikungunya patients.

 

Discussion:

Chikungunya is a re-emerging viral infection characterized by an acute febrile illness associated with polyarthralgia, conjunctivitis, and skin eruptions and is usually a self-limiting condition¹. The most common cutaneous manifestation is a maculopapular rash over trunk, limb and face. This lesion over the face is called Chik sign^2,3.  This cutaneous melanosis is usually seen on the nasolabial region as shown in various similar studies⁴. These cutaneous manifestation following a bout of acute febrile illness with polyarthralgia are suggestive of Chikungunya, so identification of this sign is of clinical significance and may help diagnosis which may further be confirmed by serological testing⁵.

 

Reference:

1. Chhabra M, Mittal V, Bhattacharya D, Rana U, Lal S. Chikungunya fever: a re-emerging viral infection. Indian J Med Microbiol. 2008;26(1):5–12.
2. Valamparampil JJ, Chirakkarot S, Letha S, Jayakumar C, Gopinathan KM. Clinical profile of Chikungunya in infants. Indian J Pediatr. 2009 Feb;76(2):151–5.
3. Kumar R, Sharma MK, Jain SK, Yadav SK, Singhal AK. Cutaneous Manifestations of Chikungunya Fever: Observations from an Outbreak at a Tertiary Care Hospital in Southeast Rajasthan, India. Indian Dermatol Online J. 2017;8(5):336–42.