Mucocutaneous features of Chikungunya fever: a study from an outbreak in West Bengal, India

Background Chikungunya fever (CF) epidemic has recently re-emerged in India on a large scale affecting many parts of the country. We have reviewed the mucocutaneous manifestations of the disease in a number of cases. Methods Twenty six serologically proven cases of CF with rash from the district of 24-Paraganas (North) in the eastern Indian state of West Bengal were subjected to detailed clinical study to investigate the chronology and evolution of mucocutaneous lesions, the type and distribution of the rash, and systemic changes. Result Most patients were in their 3rd and 4th decade (23% each). Males and females were equally affected. Most patients developed the rash concomitantly with the onset or during the febrile illness, but 5 (19.2%) developed rash after defervescence. Most (57.7%) patients developed rash within the first 2 days of fever. The upper limb was the most common site of first appearance of lesions. Morbilliform eruption was the most common type of lesion noted, followed by scaling, macular erythema, intertrigo, hypermelanosis, xerosis, excoriated papules, urticaria and petechial spots. Cutaneous lesions were generally asymptomatic but 5 (19.2%) patients had intense pruritus. Mucosal lesions were found in 4 (15.4%) patients. Moderate to marked joint involvement was universal. Conclusion CF exanthem may have varying morphology. Since the disease is spreading widely in different parts of the world, it should be considered in the differential diagnosis of any acute febrile arthropathy with rash.