Autor(es): Pakran Jaheersha, George Mamatha, Riyaz Najeeba, Arakkal Riyaz, George S-hya, Rajan Uma, Khader Anza, Thomas Sumi, Abdurahman Rahima, Sasidharanpillai Saritha, Thumbayil Lekha

Resumo: Chikungunya (CHIK) is an emerging viral disease with a myriad of cutaneous manifestations. The aim of our study was to document the morphology - evolution of skin lesions in cases presenting with fever, purpuric macules - vesiculobullous lesions, to confirm its causative relationship with CHIK, - to investigate further in order to delineate possible mechanisms of bulla formation in these cases. A prospective, descriptive hospital-based study was carried out at a tertiary health care centre in Kerala. A total of 10 patients were enrolled in the study - investigated. All cases had morbilliform eruption prior to onset of purpuric macules. Eight cases developed vesiculobullous lesions that arose either de novo or over a part or whole of the purpuric macules. Skin lesions resolved within an average of 7.6 days leaving post-inflammatory hypopigmentation. IgM CHIK enzyme-linked immunosorbent assay (ELISA) was positive in all 10 patients. Tzanck smear from the bullae showed lymphocytes in most cases along with acantholytic cells, necrotic keratinocytes or occasional neutrophils. Skin biopsy showed intraepidermal or subepidermal bullae. Immunohistochemistry revealed predominantly CD8 positive T lymphocytes in the infiltrate. The prognosis was good with supportive management alone. The clinical features in our cases are comparable to the 3 previous reports of vesiculobullous lesions in CHIK affected infants. Based on the current evidence, we hypothesize that at least 2 mechanisms are at play for these skin lesions; CHIK virus induced keratinocyte necrosis followed by a cytotoxic immune response, - possible modulation of rash by drugs. With severe epidemics of CHIK spreading from Asia - Africa to the Western hemisphere, we must consider bullous CHIK as a differential diagnosis in cases with fever - purpuric - vesiculobullous lesions.

Imprenta: International Journal of Dermatology, v. 50, n. 1, p. 61-69, 2011

Identificador do objeto digital: 10.1111/j.1365-4632.2010.04644.x

Descritores: Chikungunya virus - Cell ; Chikungunya virus - Cytopathology ; Chikungunya virus - Immune response ; Chikungunya virus - Pathogenesis ; Chikungunya virus - Proteins ; Chikungunya virus - Antibodies ; Chikungunya virus - Immune response ; Chikungunya virus - T lymphocytes ; Chikungunya virus - Viral infections ; Chikungunya Virus - Virus ; Chikungunya virus - Chikungunya fever ; Chikungunya virus - Epidemic ; Chikungunya virus - Immunology

Data de publicação: 2011

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