A 32-Year-Old with Fever, Cough, Arthralgia, and Photophobia

Differential Diagnosis

• Dengue fever
• Influenza
• Chikungunya
• Leptospirosis

Diagnosis

This patient was diagnosed with chikungunya, an arthropod-borne alphavirus endemic in sub-Saharan Africa, Southeast Asia, Indonesia, the Philippines, and India.  Additionally, since 2013 it has been reported in the Caribbean—especially the Dominican Republic. The typical clinical presentation is fever and joint pain. The incubation period is usually 3 to 7 days; however, it can be anywhere from 1 to 14 days.

Learnings/What to Look for

• Symptoms include 7-10 days of fever, chills, arthralgias, rash, myalgias, headache, and photophobia
• Arthralgias are typically migratory, symmetrical, polyarthralgia of the small joints lasting weeks to months
• Macular/maculopapular rash may develop on the trunk and extremities and, occasionally, the palms, soles, and face.  Flushing of the face and trunk may also be seen
• Rarely, mucosa and gastrointestinal hemorrhage may occur; this is more likely in children

Pearls for Urgent Care Management

• Rest, fluids, and anti-inflammatory and analgesic agents may provide symptom relief
  • Instruct patients to avoid aspirin until dengue can be ruled out to reduce risk for bleeding

Acknowledgment: Image and case presented by VisualDx (www.VisualDx.com/JUCM).