Chikungunya virus infection in a patient with Myasthenia gravis: A case report of lethal meningoencephalitis associated with high viral load.

Abstract

Chikungunya virus (CHIKV) is a reemerging arbovirus. Besides its classical acute symptoms, rare complications such as myocarditis, hepatitis, Guillain-Barré syndrome, encephalitis and meningoencephalitis are being increasingly reported worldwide Case presentation: In the present study, we report a case of lethal encephalitis caused by CHIKV associated with high viral load in an immunosuppressed patient Case report: A 45-year-old woman with medical history of Myasthenia gravis had onset of fever (Day 1), fol lowed by skin rash and polyarthralgia of large joints. Headache and lethargy started on Day 4. On Day 7, she was hospitalized, and four days later she developed neurological deterioration, being transferred to the Intensive Care Unit. Analysis of cerebrospinal fluid (CSF) suggested viral meningoencephalitis. The first CT-scan showed no significant findings, but real time quantitative PCR was positive for CHIKV in CSF with high viral load. About 24 h after the first CT-scan, brain edema was evident on the second CT-scan. On Day 26, the patient presented progressive deterioration of brain activity and died. Few other cases of patients presenting neurological compli cations associated with CHIKV were reported in Brazil already, including a patient with Myasthenia gravis and myelitis due to CHIKV Conclusions: These cases suggest such autoimmune disorder may favor CHIKV invasion of nervous system. The present case points out the potential relation of immunosuppressive conditions and severe neurological disease caused by CHIKV infection.