title: Myeloradiculopathy associated with chikungunya virus infection.
abstract: Chikungunya virus (CHIKV) is a mosquito-borne alphavirus that is endemic to parts of Africa, South and Southeast Asia, and more recently the Caribbean. Patients typically present with fever, rash, and arthralgias, though neurologic symptoms, primarily encephalitis, have been described. We report the case of a 47-year-old woman who was clinically diagnosed with CHIKV while traveling in the Dominican Republic and presented 10 days later with left lower extremity weakness, a corresponding enhancing thoracic spinal cord lesion, and positive CHIKV serologies. She initially responded to corticosteroids, followed by relapsing symptoms and gradual clinical improvement. The time lapse between acute CHIKV infection and the onset of myelopathic sequelae suggests an immune-mediated phenomenon rather than direct activity of the virus itself. Chikungunya virus should be considered in the differential diagnosis of myelopathy in endemic areas. The progression of symptoms despite corticosteroid administration suggests more aggressive immunomodulatory therapies may be warranted at disease onset.
authors: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. abank@partners.org.|Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. abank@partners.org.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. abank@partners.org.
authors: Anna M
authors: AM
authors: Bank
authors: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.|Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors: Ayush
authors: A
authors: Batra
authors: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.|Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors: Rene A
authors: RA
authors: Colorado
authors: Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.|Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
authors: Jennifer L
authors: JL
authors: Lyons
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D065632:Chikungunya Fever / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002646:Chikungunya virus / Q000472:pathogenicity / Q000502:physiology; D004293:Dominican Republic; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009437:Neuralgia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology / Q000821:virology; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D014195:Travel; D014481:United States
chemical_list: D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone
keywords: Chikungunya; Infectious myelopathy; Myelopathy; Viral myelopathy