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LETTER TO EDITOR
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 63-64

“Chik” from the womb!


1 Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
2 Department of Dermatology, Cutis Academy of Cutaneous Sciences, Bengaluru, Karnataka, India
3 Department of Dermatology, M.I.M.E.R. Medical College, Talegaon, Maharashtra, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Samipa Samir Mukherjee
Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.179503

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How to cite this article:
Mukherjee SS, Chandrashekar B S, Gaikwad RP. “Chik” from the womb!. Indian J Paediatr Dermatol 2017;18:63-4

How to cite this URL:
Mukherjee SS, Chandrashekar B S, Gaikwad RP. “Chik” from the womb!. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 5];18:63-4. Available from: http://www.ijpd.in/text.asp?2017/18/1/63/179503



Sir,

Chikungunya (CKG), derives its name from “Kungunyala,” which means “that which bends up” in Makonde language, relating to the stooped posture adopted by these patients due to incapacitating polyarthralgia or arthritis. It is caused by alphavirus and is transmitted by the Asian tiger mosquitoes, Aedes aegypti, and Aedes albopictus. The first reported outbreak of CKG in India was from Calcutta city in 1963. The mucocutaneous manifestations of the disease include facial flush, fine discrete morbilliform exanthema, and occasionally, purpura has been reported. Other reported lesions include generalized vesiculobullous eruptions, lymphedema, and intertriginous aphthous-like ulcers.[1],[2] Herein, we report a 4 days old infant with the classical chik sign with positive IgM capture ELISA specific for CKG virus with negative titers in the mother.

A 4-day-old girl child born of nonconsanguineous marriage and full term normal vaginal delivery was brought to the dermatology outpatient clinic by the parents with centrofacial pigmentation noticed since the 2nd day of life [Figure 1]. The child did not have any history of fever; there was no history of prior medications, topical application, or any significant ante natal or birth history. The mother gave history of low grade fever without any arthralgia during the 9th month of pregnancy, which was labeled as viral fever by the physician and was managed symptomatically without further evaluation. Cutaneous examination revealed slate gray to brown pigmentation over the nose, perinasal, and perioral area. No evidence of similar pigmentation was noted anywhere else on the body. Physical evaluation and systemic examination were within normal limits. The basic hematology and blood biochemistry work up was also within normal limits. The differential diagnosis considered at this point was CKG induced pigmentation, posttraumatic (birth injury), and postinflammatory hyperpigmentation. A provisional diagnosis of CKG induced pigmentation was made which was further confirmed with positive IgM capture ELISA specific for CKG virus. The titers for IgM was negative in the mother. However, her Ig G titers were positive. Thus, a final diagnosis of CKG induced pigmentation (chik sign) was established, and the child was managed conservatively with emollients and reassurance.
Figure 1: Slate gray to brown pigmentation of the nose, perinasal, and perioral area

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Pigmentary alterations in cases of suspected CKG cases have been documented in the literature. It was also found to be the most common cutaneous manifestation in one of the studies from South India.[1] They observed an asymptomatic, brownish-black pigmentation, predominantly involving the centro-facial area which was in the form of freckle-like macules, followed by diffuse, slate-colored pigmentation, flagellate pigmentation, mucosal pigmentation, and pigmentation of the existing acne lesions. The study by Riyaz et al. added melasma like pigmentation and Addisonian pigmentation to the panel of pigmentary manifestations, and they also quoted that mechanism of pigmentation could be postinflammatory.[3] An increased intraepidermal melanin dispersion/retention triggered by the virus has been postulated as a cause for pigmentation.[1] It is interesting to note that while hyperpigmentation seems to be the most common pigmentary change associated with CKG, Bhat et al. had a patient who developed hypopigmented macular lesions.[4]

The hyperpigmented lesions on the nose, malar area, and other pigmented areas show a unique histology of increased basal pigmentation, pigmentary incontinence, and melanophages as observed by others.[5],[6] However, melanophages have not been found in the series by Inamadar et al., which showed an intact basal layer with diffuse hypermelanosis of the entire epidermis and no melanin incontinence in the dermis.[1]

We herein report this case as the youngest patient to be reported with the characteristic “chik sign” and also emphasize the fact that an in utero CKG in the fetus can give rise to cutaneous manifestations in the early days of infancy. A high clinical suspicion and early recognition of the entity avoids unnecessary and expensive investigations.

Declaration of Patient Consent

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

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: Observations made during a recent outbreak in south India. Int J Dermatol 2008;47:154-9.  Back to cited text no. 1
    
2.
Mishra K, Rajawat V. Chikungunya-induced genital ulcers. Indian J Dermatol Venereol Leprol 2008;74:383-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Riyaz N, Riyaz A, Rahima, Abdul Latheef EN, Anitha PM, Aravindan KP, et al. Cutaneous manifestations of chikungunya during a recent epidemic in Calicut, North Kerala, South India. Indian J Dermatol Venereol Leprol 2010;76:671-6.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Bhat RM, Rai Y, Ramesh A, Nandakishore B, Sukumar D, Martis J, et al. Mucocutaneous manifestations of chikungunya Fever: A study from an epidemic in coastal karnataka. Indian J Dermatol 2011;56:290-4.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Shivakumar V, Rajendra O, Rajkumar V, Rajasekhar TV. Unusual facial melanosis in viral fever. Indian J Dermatol 2007;52:116-7.  Back to cited text no. 5
  Medknow Journal  
6.
Swaroop A, Jain A, Kumhar M, Parihar N, Jain S. Chikungunya fever. J Indian Acad Clin Med 2007;8:164-8.  Back to cited text no. 6
    


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