Chan Pui Shan Julia, Leung Moon Ho
Department of Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Case Rep Med. 2017;2017:2592964. doi: 10.1155/2017/2592964. Epub 2017 Mar 20.
This case report described a 40-year-old lady presented with fever, headache, arthralgia, myalgia, and impaired liver function after returning from the Philippines. Chikungunya virus (CHIKV) and dengue serology were negative. Eight weeks after initial presentation, she experienced inflammatory polyarthritis mimic rheumatoid arthritis. This time CHIKV-IgM was detected, together with a >4-fold rise of CHIKV-polyvalent-antibody titre. The first CHIKV-IgM negative sample was reexamined and was CHIKV-PCR positive. CHIKV infection was confirmed and diagnosis of CHIKV-related arthritis was made. A quarter of CHIKV infected individuals develop post-CHIKV rheumatisms that affect quality of life and may need treatment with Disease Modifying Antirheumatic Drugs. This case highlights the importance of considering CHIKV infection in patients present with symmetrical polyarthritis particularly after travel to endemic regions. Testing of both CHIKV acute and convalescent-phase serum for CHIKV antibodies and PCR is recommended in suspicious case.
本病例报告描述了一名40岁女性，从菲律宾回国后出现发热、头痛、关节痛、肌痛及肝功能损害。基孔肯雅病毒（CHIKV）和登革热血清学检测均为阴性。初次就诊8周后，她出现类似类风湿关节炎的炎症性多关节炎。此次检测到CHIKV-IgM，同时CHIKV多价抗体滴度升高4倍以上。对首份CHIKV-IgM阴性样本重新检测，结果CHIKV-PCR呈阳性。确诊为CHIKV感染，并诊断为CHIKV相关关节炎。四分之一的CHIKV感染个体可发生CHIKV感染后风湿病，影响生活质量，可能需要使用改善病情抗风湿药进行治疗。本病例强调了对于出现对称性多关节炎的患者，尤其是去过流行地区后，考虑CHIKV感染的重要性。对于可疑病例，建议检测CHIKV急性期和恢复期血清中的CHIKV抗体及进行PCR检测。
