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    Generalized brown-to-black macular hyperpigmentation, “Chik sign,” and areas of spared normal skin. This figure appears in color at www.ajtmh.org.

  • View in gallery

    Slightly reduced pigmentation and increased areas of normal skin at the follow-up examination. This figure appears in color at www.ajtmh.org.

  • 1.

    Dabas G, Vinay K, Mahajan R, 2020. Diffuse hyperpigmentation in infants during monsoon season. JAMA Dermatol 156: 99101.

  • 2.

    Garg T, Sanke S, Ahmed R, Chander R, Basu S, 2018. Stevens-Johnson syndrome and toxic epidermal necrolysis-like cutaneous presentation of chikungunya fever: a case series. Pediatr Dermatol 35: 392396.

    • Search Google Scholar
    • Export Citation
  • 3.

    Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS, 2008. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol 47: 154159.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

Chikungunya in an Infant: Diffuse Hyperpigmentation and the “Chik Sign”

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  • 1 Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India;
  • | 2 Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India;
  • | 3 Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India;
  • | 4 Department of Paediatrics, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India

A 35-day-old male infant presented with generalized hyperpigmentation. Three weeks before presentation, the child had sustained a fever for 5 days. The parents had no history of fever. Pigmentation developed 8 days after the onset of fever. He had no history of skin lesions. On examination, the child was afebrile. There was generalized macular brown-to-black hyperpigmentation with interspersed patchy areas of normal skin. Accentuated pigmentation was observed on the nose (Chik sign) and lips (Figure 1). The palms and soles exhibited diffuse hyperpigmentation. The oral mucosa was normal. Based on the clinical presentation and endemicity of chikungunya in the region, a diagnosis of chikungunya pigmentation was considered. Immunoglobulin M (IgM) antibodies against the chikungunya virus were positive, thus confirming the diagnosis. The parents were reassured and the child was followed-up. Mildly reduced pigmentation and an increased area of normal skin were observed during follow-up 1 week later (Figure 2).

Figure 1.
Figure 1.

Generalized brown-to-black macular hyperpigmentation, “Chik sign,” and areas of spared normal skin. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 3; 10.4269/ajtmh.20-1442

Figure 2.
Figure 2.

Slightly reduced pigmentation and increased areas of normal skin at the follow-up examination. This figure appears in color at www.ajtmh.org.

Citation: The American Journal of Tropical Medicine and Hygiene 105, 3; 10.4269/ajtmh.20-1442

Chikungunya fever, an arboviral disease, is endemic in India, Southeast Asia, and Africa.1 Neonatal infection can occur through maternal–fetal transmission or through mosquito bites (Aedes aegypti and Aedes albopictus). Chikungunya fever presents with fever and polyarthralgia or polyarthritis. Cutaneous manifestations can be seen in 40% to 75% of cases.2 Chikungunya is an important cause of diffuse acquired pigmentation. Generalized pigmentation is commonly seen in infants, whereas pigmentation of the centrofacial area and neck is observed in adults. Brownish pigmentation of the tip of the nose (“Chik sign” or the “brownie nose appearance”) is a characteristic presentation of chikungunya.1 Flagellate pigmentation and mucosal pigmentation can also occur. Other cutaneous features include morbilliform rash, pigmentary changes, vesiculobullous lesions, urticarial lesions, vasculitis lesions, acrocyanotic lesions, purpuric lesions, erythema multiforme-like lesions, aphthous-like ulcers, lichenoid lesions, Stevens-Johnson syndrome, and toxic epidermal necrolysis-like lesions.2,3 The diagnosis can be confirmed by testing for IgM antibodies that develop within 1 week of symptoms.1 Our case highlights the importance of pigmentary changes in the diagnosis of chikungunya in endemic countries.

References

  • 1.

    Dabas G, Vinay K, Mahajan R, 2020. Diffuse hyperpigmentation in infants during monsoon season. JAMA Dermatol 156: 99101.

  • 2.

    Garg T, Sanke S, Ahmed R, Chander R, Basu S, 2018. Stevens-Johnson syndrome and toxic epidermal necrolysis-like cutaneous presentation of chikungunya fever: a case series. Pediatr Dermatol 35: 392396.

    • Search Google Scholar
    • Export Citation
  • 3.

    Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS, 2008. Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India. Int J Dermatol 47: 154159.

    • Search Google Scholar
    • Export Citation

Author Notes

Address correspondence to Hima Gopinath, Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh 522503, India. E-mail: hima36@gmail.com

Authors’ addresses: Jami Rupa Ramani, Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, E-mail: ruparamani92@gmail.com. Hima Gopinath, Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, E-mail: hima36@gmail.com. Prabhakaran Nagendran, Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, E-mail: drprabha@aiimsmangalagiri.edu.in. Thirunavukkarasu Arun Babu, Department of Paediatrics, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India, E-mail: babuarun@yahoo.com.

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