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Revista da Sociedade Brasileira de Medicina Tropical

versão impressa ISSN 0037-8682versão On-line ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.52  Uberaba  2019  Epub 27-Jun-2019

http://dx.doi.org/10.1590/0037-8682-0015-2019 

Images in Infectious Diseases

Extensive vesiculobullous exanthema following chikungunya fever in a 13-year-old patient

Luís Arthur Brasil Gadelha Farias1 
http://orcid.org/0000-0002-8978-9903

Roberto da Justa Pires Neto1  2 

Robério Dias Leite2 

1Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil.

2Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil.


A 13-year-old girl presented to the emergency department with fever for six days and hyporexia, abdominal pain, and headache. Associated exanthematous lesions on the left upper arm and both lower limbs had appeared three days after fever onset. On physical examination, we noticed numerous purpuric and flattened bullous lesions on the upper arms, resembling extensive burns (Figure 1A-1C). She had no other complaints; no history of joint swelling, myalgia, vomiting, or conjunctivitis; and no prior drug history. Blood count, liver, and renal function test results and abdominal ultrasound were normal. Erythrocyte sedimentation rate (55 mm) and C-reactive protein (12 mg/L) levels exceeded the normal range. An immunoglobulin M enzyme-linked immunosorbent assay revealed Chikungunya virus positivity. She received symptomatic supportive treatment, adequate hydration, and rest. Antibiotics were deemed unnecessary. After approximately three days, she was asymptomatic, and the lesions regressed with skin detachment (Figure 2).

FIGURE 1: Diffused purpuric macules and vesiculobullous lesions in the upper arms. 

FIGURE 2: Skin detachment following vesiculobullous eruptions after three days of supportive treatment. 

Chikungunya fever caused by the Chikungunya virus is usually self-limiting. An early-stage rash commonly develops during the first two days of fever, followed by a maculopapular rash with centrifugal distribution. Vesiculobullous lesions in children following Chikungunya fever have been reported previously1. Hyperpigmentation, multiple aphthous-like ulcers, ecchymosis, subungual hemorrhage, and generalized erythema may also occur2. Differentials, such as autoimmune disorders, drug reactions, and viral and bacterial infections, should be excluded3. This case highlights the importance of considering Chikungunya fever as a differential diagnosis while evaluating vesiculobullous lesions in children in new endemic areas where physicians are not fully familiar with this emergent disease.

ACKNOWLEDGEMENTS

We thank the patient who agreed to participate in the study and all the staff of São José Hospital of Infectious Disease.

REFERENCES

1. Ritz N, Hufnagel M, Gérardin P. Chikungunya in Children. Pediatr Infect Dis J. 2015;34 (7):789-91. [ Links ]

2. Pakran J, George M, Riyaz N, Arakkal R, George S, Rajan U, et al. Purpuric macules with vesiculobullous lesions: a novel manifestation of Chikungunya. Int J Dermatol. 2010;50(1):61-9. [ Links ]

3. Srinivas SM, Sheth PK, Hiremagalore R. Vesiculobullous Disorders in Children. The Indian J Pediatr. 2015;82(9):805-8. [ Links ]

Ethics Approval: The study was conducted after ethical approval from the Research Ethics Committee of Hospital São José de Doenças Infecciosas (protocol number 2.405.527).

Recebido: 08 de Janeiro de 2019; Aceito: 12 de Março de 2019

Corresponding author: Luis Arthur Brasil Gadelha Farias. e-mail:luisarthurbrasilk@hotmail.com

Conflict of Interest: The authors declare that there is no conflict of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License