Objective: To report the clinical course and good neurological outcome of severe Chikungunya rhombencephalitis.

Background: Chikungunya is an emerging Aedes mosquito borne virus that is endemic in tropical, subtropical and increasingly temperate regions of the world. Neurological manifestations are reported in 5-10% patients, and associated with residual disability in 20% and mortality in 30%. We report potentially life-threatening rhombencephalitis, a rare complication of Chikungunya, in an adult with near-complete recovery.

Method: –

Results: A 37-year man, from Western India, endemic for dengue and Chikungunya, developed fever, joint pains, headaches, gait ataxia, dysarthria, dysphagia, followed by worsening sensorium over 10 days. On examination he had a generalized erythematous rash. There were prominent brainstem signs with roving eye movements, spontaneous decerebrate posturing, disordered breathing, spastic quadriparesis, depressed deep tendon reflexes and extensor plantar response. He had hepatosplenomegaly and pericarditis.
Brain MRI showed FLAIR hyperintensities involving brainstem, middle cerebellar peduncles and patchy subcortical white matter. The affected areas showed diffusion restriction and minimal contrast enhancement. Chikungunya IgM antibodies were present in serum. CSF showed raised proteins and pleocytosis. Febrile illnesses such as dengue, HSV, rabies, HIV, EBV, SARS-CoV-2, malaria, listeria were excluded.
Within 5 days of admission there was further neurological deterioration and he required ventilatory care. In addition to symptomatic treatment he was given IVIgG and ribavirin based on evidence from anecdotal reports. In the 3rd week of illness he developed an immune-mediated multisystemic inflammatory response syndrome that responded well to a brief course of oral steroids.
There was gradual clinical improvement, the ventilator could be weaned off at 5 weeks and the patient discharged at 8 weeks from symptom onset. At discharge he had significant bulbar dysfunction, ataxia and behavioral changes. On follow-up after 3 months, he showed near-complete neurological recovery.

Conclusion: We report the clinical course and favorable neurological outcome in a patient who presented with potentially life threatening Chikungunya rhombencephalitis. Our report highlights the potentially devastating neurological complications of Aedes borne emerging viruses such as Chikungunya, dengue and Zika.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/chikungunya-an-emerging-arthropod-borne-disease-presenting-as-rhombencephalitis-with-near-complete-recovery/