Huq Muhammad Rezeul, Islam Khaza Amirul, Rahman Md Aminur, Khan Ahad Mahmud
Department of Neurology, Combined Military Hospital, Dhaka, BGD.
Department of Hematology, Shaheed Ziaur Rahman Medical College Hospital, Bogra, BGD.
Cureus. 2021 Dec 28;13(12):e20783. doi: 10.7759/cureus.20783. eCollection 2021 Dec.
Chikungunya fever is a re-emerging viral illness affecting different parts of the world. Most patients recover without any serious complications. Here, we present a rare case of chikungunya fever with severe neutropenia and moderate thrombocytopenia. A 31-year-old male presented with a fever, body aches, and rash. Serial full blood counts revealed a very low neutrophil count (0.273 × 10/L) with a low platelet count (56 × 10/L). Dengue fever was excluded by doing both antigen and antibody tests. The IgM antibody against the chikungunya virus was positive. After giving one dose of granulocyte colony-stimulating factor (G-CSF) filgrastim, the neutropenia resolved. A few days later, the thrombocytopenia resolved as well. Other than episodic attacks of arthritis, he recovered completely. The absence of severe neutropenia and thrombocytopenia is considered a major demarcating feature between chikungunya fever and dengue fever. Cases like this one put physicians in a difficult position regarding accurate diagnosis and appropriate management plans. The use of filgrastim may be considered as rescue therapy in a situation like this.
基孔肯雅热是一种再次出现的病毒性疾病，影响着世界不同地区。大多数患者康复时没有任何严重并发症。在此，我们报告一例罕见的基孔肯雅热病例，伴有严重中性粒细胞减少和中度血小板减少。一名31岁男性出现发热、身体疼痛和皮疹。连续血常规检查显示中性粒细胞计数极低（0.273×10⁹/L），血小板计数低（56×10⁹/L）。通过进行抗原和抗体检测排除了登革热。抗基孔肯雅病毒的IgM抗体呈阳性。给予一剂粒细胞集落刺激因子（G-CSF）非格司亭后，中性粒细胞减少症得到缓解。几天后，血小板减少症也得到缓解。除了间歇性关节炎发作外，他完全康复。严重中性粒细胞减少和血小板减少的缺失被认为是基孔肯雅热和登革热之间的主要区别特征。这样的病例使医生在准确诊断和制定适当的治疗方案方面陷入困境。在这种情况下，可考虑使用非格司亭作为挽救治疗。
