|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 286-287
Atypical dermatological manifestation of neonatal chikungunya
Amitabh Singh1, Anirban Mandal2
1 Department of Pediatrics, Vardhaman Mahavir Medical College and Sadarjung Hospital, New Delhi, India
2 Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
|Date of Web Publication||28-Jun-2018|
Dr. Anirban Mandal
Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi - 110 016
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh A, Mandal A. Atypical dermatological manifestation of neonatal chikungunya. Indian J Paediatr Dermatol 2018;19:286-7
|How to cite this URL:|
Singh A, Mandal A. Atypical dermatological manifestation of neonatal chikungunya. Indian J Paediatr Dermatol [serial online] 2018 [cited 2020 Jan 28];19:286-7. Available from: http://www.ijpd.in/text.asp?2018/19/3/286/216947
Chikungunya, an arboviral disease, is transmitted by the bite of infected Aedes mosquito (species aegypti and albopictus), can present with a host of dermatological manifestations., Neonatal Chikungunya infection can be either due to vertical transmission or acquired postnatally; it poses a diagnostic challenge to the clinician.
A 12-day-old male neonate, second born to a nonconsanguineously married couple, at term, by normal vaginal delivery, at a hospital with a birth weight of 2.88 kg, presented with fever and skin rash. There was no significant antenatal history in the mother including fever and the neonate also had an uneventful immediate perinatal period. He was exclusively breastfed. The symptom started with abrupt onset of high grade (up to 104°F) fever, irritability and excessive crying followed by development of hyperpigmented skin rash over next few hours. Over next 12 h, the infant developed swelling over the legs followed by skin-peeling within 24 h, without any preceding vesicular or pustular lesions. There was no history of poor feeding, jaundice, difficulty in breathing, vomiting, loose stools, abdominal distention, decreased urine output, seizure or bleeding from any site. At presentation, the child was febrile but hemodynamically stable. There were macular hyperpigmented, coalescing lesions over trunk and limbs [Figure 1]a and burn-like peeling of skin noticed over lower limbs [Figure 1]b without any mucosal involvement. There was no evidence of jaundice, bleeding or organomegaly; other systemic examination was also essentially within normal limits. Investigations revealed a normal sepsis screen (total leukocyte count, absolute neutrophil count, immature to total neutrophil ratio, micro erythrocyte sedimentation rate) except a high C-reactive protein (26 mg/dl), thrombocytopenia (platelet 76,000/mm3) but coagulation parameters, liver and renal function tests were within normal limits. Subsequently, blood and urine culture were sterile and culture from the peeling skin lesions also did not grow any organism. The diagnosis of neonatal Chikungunya was made with a positive reverse transcriptase polymerase chain reaction and subsequently further confirmed with a positive Chikungunya IgM in the child. The mother was asymptomatic and also had a negative Chikungunya IgM and IgG, thus proving this to be a postnatally acquired infection. The child was managed with oral paracetamol breast feeding and dressing of the peeling skin lesions with topical antibiotic (Soframycin) and paraffin gauge. Fever improved over next 4 days and the skin lesions also healed completely over next 3 weeks, without any residual pigmentation.
|Figure 1: A 12-day-old, male neonate with fever and (a) Hypermigmented, macular, coalescing skin lesions over trunk and limbs; (b) Burn-like peeling skin lesions over bilateral lower limbs and edema over the dorsum of (right) foot|
Click here to view
The range of dermatological manifestations described with Chikungunya includes pigmentation, generaised erythema, maculopapular lesions, vesico-bulous lesions, peteche, acrocyanosis, gutted psoriasis and exacerbation of existing skin disease (lichen planus, psoriasis). Pigmented lesions, the most common skin lesion in infants and children with Chikungunya, may be in the form of generalized pigmentation, macular, striking pigmentation on the nose called “brownie nose” or the “Chik” sign, freckle-like pigmented macules that tend to coalesce (seen in our case), pinpoint confetti-like macules, irregular flagellate or whiplash pattern of brownish pigmentation, accentuation of melasma, pigmentation of existing acne lesions, periorbital hypermelanosis and Addisonian-type palmar pigmentation. Recently some atypical pigmentation has been reported in cases Chikungunya fever by Dhar & Srinivas. The peeling skin lesion seen in our case has been described previously only by Seetharam, et al. and Valamparampil, et al. The peeling skin lesions may resemble staphylococcal scalded skin syndrome (SSSS); however, unlike SSSS our child was nontoxic and there was no apparent tenderness in the lesions.
To conclude, one must be aware of the wide spectrum of dermatological manifestations of Chikungunya infection, especially in the endemic regions, for a rapid diagnosis and appropriate management, including avoidance of unnecessary investigations and unwarranted medications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Seetharam KA, Sridevi K, Vidyasagar P. Cutaneous manifestations of chikungunya fever. Indian Pediatr 2012;49:51-3.
Sebastian MR, Lodha R, Kabra SK. Chikungunya infection in children. Indian J Pediatr 2009;76:185-9.
Vasani R, Kanhere S, Chaudhari K, Phadke V, Mukherjee P, Gupta S, et al
. Congenital Chikungunya - A Cause of Neonatal Hyperpigmentation. Pediatr Dermatol 2016;33:209-12.
Dhar S, Srinivas S. A child with peculiar pigmentation after a bout of fever. Pediatric Dermatology 2018;35:408-9.
Valamparampil JJ, Chirakkarot S, Letha S, Jayakumar C, Gopinathan KM. Clinical profile of Chikungunya in infants. Indian J Pediatr 2009;76:151-5.