Lobular panniculitis associated with chikungunya fever: A case report

Sangmala, Siripan; Eksomtramage, Thanadon; Aiempanakit, Kumpol; Chiratikarnwong, Kanokphorn; Auepemkiate, Sauvarat

doi:10.1016/j.idcr.2018.e00462

Cited by 6 publications

(10 citation statements)

References 5 publications

(13 reference statements)

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“…In the urban transmission cycle, infected humans fuel the outbreak as they amplify the virus for circulating Aedes mosquitos to effectively transmit the virus to others (27). After an incubation period of 2-10 days, most patients develop an abrupt onset high-grade fever associated with typical characteristics of chikungunya infection, like arthralgia, myalgia, and rash (28)(29)(30)(31)(32)(33)(34)(35). The majority of patients recover after a spontaneous self-limiting illness.…”

Section: Introductionmentioning

confidence: 99%

Chikungunya Manifestations and Viremia in Patients Who Presented to the Fever Clinic at Bangkok Hospital for Tropical Diseases During the 2019 Outbreak in Thailand

Imad¹,

Phadungsombat²,

Nakayama³

et al. 2020

Preprint

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Chikungunya virus is an Alphavirus belonging to the family Togaviridae that is transmitted to humans by an infected Aedes mosquito. Patients develop fever, inflammatory arthritis, and rash during the acute stage of infection. Although the illness is self-limiting, atypical and severe cases are not uncommon, and 60% may develop chronic symptoms that persist for months or even for longer durations. Having a distinct periodical epidemiologic outbreak pattern, chikungunya virus reappeared in Thailand in December 2018. Here, we describe a cohort of acute chikungunya patients who had presented to the Bangkok Hospital for Tropical Diseases during October 2019. Infection was confirmed by real-time RT-PCR using serum collected at presentation to the Fever Clinic. Other possible acute febrile illnesses such as influenza, dengue, and malaria were excluded. We explored the sequence of clinical manifestations at presentation during the acute phase and associated the viral load with the clinical findings. Most of the patients were healthy individuals in their forties. Fever and arthralgia were the predominant clinical manifestations found in this patient cohort, with a small proportion of patients with systemic symptoms. Higher viral loads were associated with arthralgia, and arthralgia with the involvement of the large joints was more common in female patients

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Section: Introductionmentioning

confidence: 99%

Chikungunya Manifestations and Viremia in Patients Who Presented to the Fever Clinic at Bangkok Hospital for Tropical Diseases During the 2019 Outbreak in Thailand

Imad¹,

Phadungsombat²,

Nakayama³

et al. 2020

Preprint

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“…The third mechanism involves panniculitis associated with the virus directly detectable in the subcutaneous tissue (either by immunohistochemistry or by PCR) and may represent a bona fide viral infection, with very few examples in the literature (Table 1). 4,7,8,21 The latter may be attributable to the difficulties of documenting viral infection in tissues. Of note, in Table 1, extranodal NK/T‐cell lymphoma, nasal type has a very strong association with EBV and may involve the subcutaneous fat; however, it is arguably not a viral infection of fat per se 7 .…”

Section: Discussionmentioning

confidence: 99%

“…Among infection‐induced panniculitides, viral panniculitis represents a minor category, with only a few anecdotal reports 4‐9 . Herein, we describe a case of viral panniculitis in a patient with disseminated opportunistic Enterovirus infection, where polymerase chain reaction (PCR) analysis at the Centers for Disease Control and Prevention demonstrated Coxsackievirus A9 in the skin, and review the relevant literature.…”

Section: Introductionmentioning

confidence: 97%

Viral panniculitis in a patient with disseminated opportunistic Enterovirus infection

et al. 2020

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Infection‐induced panniculitis has been described in association with a broad range of microorganisms. Among those, viral panniculitis represents a minor category, with only a few anecdotal reports in the literature documenting viral infection in the subcutaneous fat. Herein, we report a woman in her 30s with seropositive rheumatoid arthritis on rituximab and prednisone, who presented with a 6‐month history of progressive multisystem manifestations, including unintentional weight loss, fever, fatigue, myopathy, pancreatitis, and sensorineural hearing loss. She had indurated plaques on her thighs characterized by predominantly lobular panniculitis with chronic lymphohistiocytic inflammation. Molecular studies performed at the Centers for Disease Control and Prevention identified evidence of Enterovirus group with the highest identity of Coxsackievirus A9. Enterovirus RNA was also detected in the cerebrospinal fluid and muscle. Based on the findings, a diagnosis of disseminated enteroviral infection in the setting of B‐cell depletion was rendered. To the best of our knowledge, this represents the first reported case of viral panniculitis with documentation of Coxsackievirus A9 in the skin. Since rituximab may be used for the treatment of autoimmune dermatological diseases, familiarity of the potential occurrence of severe enteroviral infections in the setting of immunosuppressive treatment is important for dermatopathologists.

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“…The rare cutaneous forms are hemorrhagic manifestations, vesiculobullous rash, and panniculitis. 2,3 Hemorrhagic lesions are infrequent in Chikungunya fever. There is a variation of hemorrhage from subungual hemorrhage, and multiple ecchymotic patches, to purpura fulminans with few severities.…”

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confidence: 99%

“…Recently, panniculitis, the inflammation of subcutaneous fat, is the erythematous, painful nodule on the lower extremities ( Figure 1H). 2 The variation of cutaneous lesions in the Chikungunya disease makes it challenging to diagnose. Further studies, especially comparisons with other viral infections, should be conducted in order to develop more specific and sensitive skin criteria.…”

mentioning

confidence: 99%