final program.qxd - Parallels Plesk Panel

PP 6.3
Imported Chikungunya related chronic poly-arthritis : 2 cases
Rapp c, Ficko C, imbert P, Barruet R, Debord T
department of infectious and tropical diseases Military Hospital Bégin,
94163 Saint-Mandé, France
Over the past year, the Comoros and the Reunion Island have been successively
affected by a severe epidemic of Chikungunya virus infections. In addition to the rare
severe neurological forms described in the Reunion Island, the possibility of chronic
poly-arthritis deserves to be known in France.
Case1: In May 2005, a 49 year old Comorian woman presented with an acute febrile
poly-arthritis (hands, left hip and ankles), 7 days after her return from a month stay in
Moroni.
We observed a limitation of the left hip and an edema of the ankles and of the distal
interphalangeal joints. The CRP was 16 mg/L (N < 1). The radiographs were normal. The
Chikungunya serology (IgM) was positive. After an initial response to Non-Steroidal
Anti-Inflammatory treatment, the evolution was marked with chronic pain and morning
stiffness.The search for inflammatory poly-arthritis was negative (ANA, anti-dsDNA,
rheumatoid factors). The disabling symptomatology improved in the seventh month after
many NSAI treatments.
Case 2: In December 2005, a 69 year old woman presented with a congestive chronic
poly-arthritis (wrists, ankles, shoulders and hips) evolving for more than 2 months after a
Chikungunya infection contracted in the Reunion Island and serologically confirmed. The
diagnosis of chronic inflammatory rheumatism was ruled out, the outcome was slowly
favourable.
The scale of the current epidemic is the opportunity to remind that the articular tropism of
the Chikungunya virus can mimic inflammatory rheumatism in its initial stage, particularly
in women over 40 years old. Spared hips in the rare retrospective series can also be
affected.This viral poly-arthritis, described initially in Africa and easily diagnosed in an
epidemic stage should henceforth be considered in front of a sporadic case of
poly-arthritis in travellers .
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