Myeloradiculopathy associated with chikungunya virus infection

Abstract

Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is endemic to parts of Africa, South and Southeast Asia, and more recently the Caribbean. Patients typically present with fever, rash, and arthralgias, though neurologic symptoms, primarily encephalitis, have been described. We report the case of a 47-year-old woman who was clinically diagnosed with CHIKV while traveling in the Dominican Republic and presented 10 days later with left lower extremity weakness, a corresponding enhancing thoracic spinal cord lesion, and positive CHIKV serologies. She initially responded to corticosteroids, followed by relapsing symptoms and gradual clinical improvement. The time lapse between acute CHIKV infection and the onset of myelopathic sequelae suggests an immune-mediated phenomenon rather than direct activity of the virus itself. Chikungunya virus should be considered in the differential diagnosis of myelopathy in endemic areas. The progression of symptoms despite corticosteroid administration suggests more aggressive immunomodulatory therapies may be warranted at disease onset.

Zika might not be acting alone: Using an ecological study approach to investigate potential co-acting risk factors for an unusual pattern of microcephaly in Brazil

“…Others have linked the outbreak of Guillain-Barre syndrome, firstly related to the Zika virus outbreak in 2015 in the city of Salvador, with the concurrent intense chikungunya transmission [ 50 ]. It is important to note that chikungunya infection can result in neurologic manifestations such as encephalitis [ 79 ], encephalopathy [ 43 , 80 ], peripheral neuropathy (including Guillain-Barre syndrome) [ 46 , 81 – 82 ]. In addition, chikungunya virus infection may result in complications during pregnancy either to the mother or to the newborn [ 83 – 84 ].…”

Prevalence of chronic chikungunya and associated risks factors in the French West Indies (La Martinique): A prospective cohort study

“…CHIKV is known to target human epithelial and endothelial cells, fibroblasts and macrophages [13][14][15], as well as human muscle satellite cells [16]. The virus is also suspected of neurotropism [17,18], which can lead to neurological complications [19][20][21][22].…”

The Range of Neurological Complications in Chikungunya Fever

“…Thereby, neurological complications take center stage: Accounting for up to 25% of atypical cases and up to 60% of severe atypical cases, they are a major cause of ICU admission and death in CHIKF [16,17]. Reports range from encephalitis, optic neuritis, myeloradiculitis to Guillain-Barré-Syndrome (GBS), causing drastic sequelae such as mental disability, blindness and persisting paralysis -also in young and previously healthy persons [18][19][20][21][22][23][24][25][26]. In many cases, neurological signs start after a symptom-free interval of 1-3 weeks, pointing to an autoimmune process [21][22][23][24][25][26].…”

“…Reports range from encephalitis, optic neuritis, myeloradiculitis to Guillain-Barré-Syndrome (GBS), causing drastic sequelae such as mental disability, blindness and persisting paralysis -also in young and previously healthy persons [18][19][20][21][22][23][24][25][26]. In many cases, neurological signs start after a symptom-free interval of 1-3 weeks, pointing to an autoimmune process [21][22][23][24][25][26]. Given the challenge of this variety and the forecast that CHIKF will continue its spread to more temperate regions such as the USA and Europe in the future [27], neurologists should be aware of the typical aspects of Neuro-Chikungunya.…”