title: Chikungunya fever: Atypical and lethal cases in the Western hemisphere: A Venezuelan experience.
abstract: A large epidemic of Chikungunya fever currently affects the Caribbean, Central and South America. Despite a high number of reported cases, little is known on the occurrence of severe clinical complications. We describe four Venezuelan patients with a severe and/or lethal course who exhibit unusual manifestations of the disease. Case 1 describes a 75 year-old man with rapid onset of septic shock and multi-organ failure. Cases 2 and 3 describe two patients with rapid aggressive clinical course who developed shock, severe purpuric lesions and a distinct area large of necrosis in the nasal region. Case 4 depicts a splenectomized woman with shock, generalized purpuric lesions, bullous dermatosis and acronecrosis of an upper limb. Chikungunya fever in the Western hemisphere may also associate with atypical and severe manifestations. Some patients experience a life-threatening, aggressive clinical course, with rapid deterioration and death due to multisystem failure.
authors.affiliation: Infectology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Jaime R
authors.initials: JR
authors.lastname: Torres
authors.affiliation: Infectology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Bolivarian Republic of Venezuela.
authors.lastname: Leopoldo Códova G
authors.affiliation: Infectology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Julio S
authors.initials: JS
authors.lastname: Castro
authors.affiliation: Infectious Diseases Service, Centro Médico Docente La Trinidad, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Libsen
authors.initials: L
authors.lastname: Rodríguez
authors.affiliation: Infectology Section, Tropical Medicine Institute, Universidad Central de Venezuela, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Víctor
authors.initials: V
authors.lastname: Saravia
authors.affiliation: Clínica RESCARVEN de Chuao, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Joanne
authors.initials: J
authors.lastname: Arvelaez
authors.affiliation: Policlínica Metropolitana, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ríos-Fabra
authors.affiliation: Policlínica Metropolitana, Caracas, Bolivarian Republic of Venezuela.
authors.forename: María A
authors.initials: MA
authors.lastname: Longhi
authors.affiliation: Clínica RESCARVEN de Chuao, Caracas, Bolivarian Republic of Venezuela.
authors.forename: Melania
authors.initials: M
authors.lastname: Marcano
keywords: Chikungunya fever; Hemorrhagic fever; Severe; Western hemisphere