CLINICAL BRIEFS A Child with Serious Chikungunya Virus (CHIKV) Infection Requiring Intensive Care, After an Outbreak P. Ramesh Menon & Krishnan C. & Jayaram Sankar & K. M. Gopinathan & Girija Mohan Received: 22 April 2010 / Accepted: 2 August 2010 / Published online: 28 August 2010 # Dr. K C Chaudhuri Foundation 2010 Abstract A 5 1/2-yr-old boy presented with high grade fever for 4 days, and cervical adenitis, body ache, arthralgia, followed by sudden onset of breathlessness. He had clinical, electrocardiographic and echo evidence of myocarditis and congestive cardiac failure. An enzyme- linked immunosorbent assay (MAC-IgM ELISA) with serum collected 5 days after disease onset showed IgM antibodies to CHIKV. He was managed conservatively and started showing symptomatic improvement by 3 days. At discharge, a repeat Echocardiogram (a week later) showed normal left ventricular (LV) function with mild Mitral regurgitation. On follow up, after 2 months, child remains asymptomatic. Other common aetiological agents were screened for and found negative. This may indicate a probable cardiac tropism for the virus. Keywords Cardiac dysfunction . Critically ill child . Viral infections Introduction La Réunion (island) outbreak of chikungunya fever, in 2005–2006, in the Indian Ocean [1] and in India [2], has brought hitherto unknown manifestations of the arthropod borne alphavirus infection to light in the last couple of years [1]. The first outbreak occurred in Kerala, India during 2006 affecting 14 districts [3], followed by another during May 2007 [4] affecting almost whole of the State. The clinical symptoms, in a survey of the most affected areas, highlighted high fever, severe myalgia and prolonged arthralgia, with occasional history of skin itch/rash (petechiae) [5]. Persistent symptoms of arthralgia and recurrence of minor symptoms are extremely common in these areas [2, 5]. Myocarditis induced by CHIKV, initially reported in the 1970s, is rare [6]. A few cases have been recently observed in the Reunion outbreak [1]. Even among adults, the reported occurrence is uncommon. Jérôme L et al. [1] reported only one case of myocarditis among the confirmed chikungunya virus specific manifestations in 33 patients. This condition, which was thought to be benign, could lead to dilated cardiomyopathy, as observed in other viral infections [7]. Case report A 5 1/2-yr-old boy from Aryad was admitted to Pediatric lCU on 12/05/09 with complaints of high grade fever for 4 days, and cervical adenitis, bodyache, arthralgia, followed by sudden onset of breathlessness. Clinical examination revealed a toxic look, pallor, pedal edema, and cervical lymphadenopathy. Evidence of congestive cardiac failure was seen. The pulse was 112/min, regular, low volume with cold extremities; a respiratory rate of 40/min, regular; BP 90/60 mm Hg. Apex beat was localized in 5th left ICS in midclavicular line, a muffled S1 and an S3 gallop. There was tender hepatomegaly and ascites. There was arthritis of both the knee joints Other systems were normal. The investigation reports showed: Hb 10.2 g/dL, Total Leucocyte Count: 13,100 mm3, P57L38E5, ESR: 80 mm/hr, platelet count: 320×10 3 /mm 3 , C-Reactive protein (CRP): 2.4 mg/L; random blood sugar electrolytes, serum transaminases (SGOT, SGPT), bilirubin, urea and creatinine were normal. The blood culture was sterile. The chest roentgenogram showed gross cardiomegaly,with a Cardio Thoracic (CT) P. R. Menon (*) : K. C. : J. Sankar : K. M. Gopinathan : G. Mohan Department of Pediatrics, Govt. TD Medical College, Alappuzha, Kerala 688005, India e-mail: rpmpgi@gmail.com Indian J Pediatr (2010) 77:1326–1328 DOI 10.1007/s12098-010-0174-2