• 1.

    Rougeron V, Sam IC, Caron M, Nkoghe D, Leroy E, Rogues P, 2014. Chikungunya, a paradigm of neglected tropical disease that emerged to be a new health global risk. J Clin Virol 64: 144152.

    • Search Google Scholar
    • Export Citation
  • 2.

    Chang LJ, Dowd KA, Mendoza FH, Saunders JG, Sitar S, Plummer SH, Yamshchikov G, Sarwar UN, Hu Z, Enama ME, Bailer RT, Koup RA, Schwartz RM, Akahata W, Nabel GJ, Mascola JR, Pierson TC, Graham BS, Ledgerwood JE, VRC 311 Study Team, 2014. Safety and tolerability of chikungunya virus-like particle vaccine in healthy adults: a phase 1 dose-escalation trial. Lancet 384: 20462052.

    • Search Google Scholar
    • Export Citation
  • 3.

    Borgherini G, Poubeau P, Staikowsky F, Lory M, Le Moullec N, Becquart JP, Wengling C, Michault A, Paganin F, 2007. Outbreak of chikungunya on Reunion Island: early clinical and laboratory features in 157 adult patients. Clin Infect Dis 44: 14011407.

    • Search Google Scholar
    • Export Citation
  • 4.

    Economopoulou A, Dominguez M, Helynck B, Sissoko D, Wichmann O, Quenel P, Germonneau P, Quatresous I, 2009. Atypical chikungunya virus infections: clinical manifestations, mortality and risk factors for severe disease during the 2005–2006 outbreak on reunion. Epidemiol Infect 137: 534541.

    • Search Google Scholar
    • Export Citation
  • 5.

    Burt FJ, Rolph MS, Rulli NE, Mahalingam S, Heise MT, 2012. Chikungunya: a re-emerging virus. Lancet 379: 662671.

  • 6.

    Sharp TM, Roth NM, Torres J, Ryff KR, Pérez Rodríguez NM, Mercado C, Pilar Diaz Padró MD, Ramos M, Phillips R, Lozier M, Arriola CS, Johansson M, Hunsperger E, Muñoz-Jordán JL, Margolis HS, García BR, Centers for Disease Control and Prevention (CDC), 2014. Chikungunya cases identified through passive surveillance and household investigations—Puerto Rico, May 5–August 12, 2014. MMWR Morb Mortal Wkly Rep 63: 11211128.

    • Search Google Scholar
    • Export Citation
  • 7.

    Kendrick K, Stanek D, Blackmore C, 2014. Notes from the field: transmission of chikungunya virus in the continental United States—Florida, 2014. MMWR Morb Mortal Wkly Rep 63: 1137.

    • Search Google Scholar
    • Export Citation
  • 8.

    Rajapakse S, Rodrigo C, Rajapakse A, 2010. Atypical manifestations of chikungunya infection. Trans R Soc Trop Med Hyg 104: 8996.

  • 9.

    Staples JE, Breiman RF, Powers AM, 2009. Chikungunya fever: an epidemiological review of a re-emerging infectious disease. Clin Infectious Dis 49: 942948.

    • Search Google Scholar
    • Export Citation
  • 10.

    Thiberville SD, Moyen N, Dupuis-Maguiraga L, Nougairede A, Gould EA, Roques P, de Lamballerie X, 2013. Chikungunya fever: epidemiology, clinical syndrome, pathogenesis and therapy. Antiviral Res 99: 345370.

    • Search Google Scholar
    • Export Citation
  • 11.

    Schilte C, Staikowsky F, Couderc T, Madec Y, Carpentier F, Kassab S, Albert ML, Lecuit M, Michault A, 2013. Chikungunya virus-associated long-term arthralgia: a 36-month prospective longitudinal study. PLoS Negl Trop Dis 7: e2137.

    • Search Google Scholar
    • Export Citation
  • 12.

    Gibbons RV, Vaughn DW, 2002. Dengue: an escalating problem. BMJ 324: 15631566.

  • 13.

    Prince HE, Seaton BL, Matud JL, Batterman HJ, 2014. Chikungunya virus RNA and antibody testing at a national reference laboratory since emergence of Chikungunya in the Americas. Clin Vaccine Immunol 22: 291297.

    • Search Google Scholar
    • Export Citation
  • 14.

    Ray P, Ratagiri VH, Kabra SK, Lodha R, Sharma S, Sharma BS, Kalaivani M, Wig N, 2012. Chikungunya infection in India: results of a prospective hospital based multi-centric study. PLoS One 7: e30025.

    • Search Google Scholar
    • Export Citation
  • 15.

    Panning M, Grywna K, van Esbroeck M, Emmerich P, Drosten C, 2008. Chikungunya fever in travelers returning to Europe from the Indian Ocean region, 2006. Emerg Infect Dis 14: 416422.

    • Search Google Scholar
    • Export Citation

 

 

 

 

A Case of Diabetic Ketoacidosis Following Chikungunya Virus Infection

View More View Less
  • Division of Medical Education, Department of Internal Medicine, Washington University in St. Louis, Missouri; Barnes Jewish Hospital, St. Louis, Missouri

Chikungunya is a mosquito-borne viral disease that has recently become endemic in the Caribbean, including the island of Puerto Rico. We present the case of a 50-year-old Puerto Rican man who traveled to St. Louis for business and was diagnosed with acute chikungunya virus infection with atypical features causing diabetic ketoacidosis. This case highlights the need to keep tropical infectious diseases on the differential diagnosis in appropriate individuals and the ways in which tropical infectious diseases can masquerade as part of common presentations.

Author Notes

* Address correspondence to Timothy Laux, Department of Medicine, Division of Medical Education, Washington University School of Medicine, Box 8121, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail: laux.timothy@gmail.com

Authors' addresses: Illya Tolokh, Timothy Laux, and Daniel Kim, Department of Medicine, Division of Medical Education, Washington University School of Medicine, St. Louis, MO, E-mails: itolokh@dom.wustl.edu, laux.timothy@gmail.com, and crfirmd1@dom.wustl.edu.

Save