Title : Beyond arthralgia: An unusual pulmonary presentation of chikungunya
Abstract:
Background: Chikungunya is a mosquito-borne viral infection that commonly manifests as fever, arthralgia, and skin rash. Although predominantly associated with musculoskeletal symptoms, pulmonary complications have occasionally been reported. We describe the clinical and imaging findings of a patient with PCR-confirmed Chikungunya infection who developed radiological features of atypical pneumonia.
Case Presentation: A 61-year-old man with a known history of hypertrophic obstructive cardiomyopathy and diabetes mellitus presented with high-grade fever and productive cough lasting two days. Respiratory examination revealed bilateral basal crepitations. Laboratory evaluation showed thrombocytopenia and neutrophilia, while liver and renal function parameters remained within normal limits. Investigations for dengue, leptospirosis, malaria, influenza, and COVID-19 were negative. Chikungunya virus infection was subsequently confirmed by PCR. Initial chest radiography revealed multiple patchy and nodular opacities in both lungs, predominantly on the right side. Follow-up radiographs demonstrated interval worsening, followed by progressive improvement. HRCT of the chest showed multifocal confluent and non-confluent ground-glass opacities, predominantly involving the bilateral upper lobes, indicating an atypical pneumonic pattern. The patient was treated with supportive measures, including antipyretics and intravenous fluids, along with empirical antibiotic therapy. His clinical condition gradually improved, with resolution of fever, persistently stable oxygenation, and recovery of the platelet count. He was subsequently discharged after clinical improvement, with follow-up chest radiography demonstrating substantial resolution of the pulmonary opacities.
Conclusion: Pulmonary involvement represents an unusual presentation in patients with Chikungunya virus infection. In this case, HRCT demonstrated multifocal ground-glass opacities, while serial chest radiographs documented the progression and subsequent regression of pulmonary abnormalities. These findings emphasize the importance of radiological assessment in identifying and monitoring atypical pulmonary presentations of acute viral infections. Chikungunya may be included in the differential diagnosis of atypical pneumonia in endemic settings when supported by clinical and laboratory findings.
Keywords: Chikungunya Virus; Pulmonary Involvement; Atypical Pneumonia; Ground-Glass Opacities; HRCT; Chest Radiography
