A 40 years old female came to OPD with a history of fever, joint pain and rash. NSAIDs were prescribed. After one week, the patient developed brownish discoloration over the nose. This was due to:
Fixed drug eruption
Ans. C. Chikungunya
Clinical history of fever, joint pain and rash and after one week of NSAIDs use, the patient developed brownish discoloration over the nose as given in the image, the most probable diagnosis is pigmentation caused by Chikungunya. Nose pigmentation is striking in the cases of CKG, which has not been reported in any other viral exanthem. For fixed drug eruption, the mucocutaneous junction ( lip, glans) is most frequently involved, genital skin (glans) is the most commonly involved site.
- Chikungunya fever is a re-emerging disease characterized by fever with arthralgia.
- The abrupt onset of chikungunya virus disease follows an incubation period of 2-10 days.
Etiology & Epidemiology:
- Etiology: Chikungunya virus
- Aedes aegypti & A. albopictus mosquito bites; primarily in Africa & Indian Ocean region
- The maternal-fetal transmission has been reported
- Most common among adults
- Fever (often severe) with a saddleback pattern & severe arthralgia; accompanied by chills & constitutional symptoms
- & signs (abdominal pain, anorexia, conjunctival injection, headache, nausea & photophobia)
- Severe polyarticular, migratory arthralgias, especially involving small joints (e.g., hands, wrists, ankles)
- Recovery may require weeks, and some elderly patients may continue to experience joint pain, recurrent effusions, or stiffness for several years
Description of Rash
- Maculopapular eruption; prominent on upper extremities & face, but can also occur on trunk & lower extremities
- Viral isolation (in mosquito cell lines) & RT-PCR are best for early diagnosis.
- Serum antibody detection: MAC-ELISA is the best serology test.
- Markers like IL-113 & IL-6 are increased & RANTES level is decreased
- NSAIDs & sometimes chloroquine for refractory arthritis.