Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter To Editor
2008:74:4;383-384
doi: 10.4103/0378-6323.42903
PMID: 18797064

Chikungunya-induced genital ulcers

Katyayan Mishra1 , Vishwesh Rajawat2
1 Consultant Dermatologist, Ujjain (Madhya Pradesh), India
2 Department of Pathology, Shri Aurobindo Institute of Medical Sciences, Indore (Madhya Pradesh), India

Correspondence Address:
Katyayan Mishra
Skin Clinic, Rawal Market, Tower Chowk, Ujjain - (M.P.) 456 001
India
How to cite this article:
Mishra K, Rajawat V. Chikungunya-induced genital ulcers. Indian J Dermatol Venereol Leprol 2008;74:383-384
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Chikungunya fever, which is caused by a togavirus (arboviral infection), manifests as an acute illness of fever, headache, arthralgia, vomiting, abdominal pain, sore throat, conjunctivitis and lymphadenopathy. [1] The chikungunya virus was first isolated from patients and Aedes aegypti mosquitoes from Tanzania in 1952. The virus first appeared in India in 1963 when along with dengue, it caused very extensive epidemics in Calcutta, Madras and other areas. This current outbreak had started in June-July in 2006. It presents as a fever of sudden onset, crippling joint pains, lymphadenopathy and conjunctivitis. A total of 60098 suspected cases were reported, out of which 70 cases were confirmed by serum ELISA test. [2]

A maculopapular rash [3] is common and some cases even show hemorrhagic manifestations, [4] which have not been reported after 1973. The fever is typically biphasic with a period of remission of 1-6 days. No vaccine is available. Various outbreaks have been reported from Asia, East Africa and peninsular India. The incubation period is 2-4 days and the illness is self-limiting with two phases of fever lasting for about 3-10 days.

Very few reports of dermatological manifestations exist. [5],[6] During the recent epidemic of chikungunya fever in central India, we encountered 16 young adult males with penoscrotal ulcerations. All patients were in the age group of 20-45 years, and had developed these ulcers after about 13-35 days of developing fever, clinically thought to be chikungunya. Apart from the fever with chills, they had headache, nausea, vomiting and joint pains. The skin lesions were punched-out, deep ulcers with undermined edges showing healthy granulation tissue in the floor but erythema and thickening in the surrounding skin [Figure - 1]. The size of the ulcers varied from 0.5-2 cm in diameter and their shape was round to oval or irregular. The number of ulcers per patient ranged from 1-3.

These patients were from a rural background and were clinically diagnosed as Chikungunya. However, no viral isolation or culture was performed in these cases as the facilities to perform these techniques were unavailable in rural India. Blood counts were normal in all the cases. Bacterial cultures of the material from the ulcers were performed in three cases and did not grow any organisms after 72 hours of inoculation. Biopsy from the edge of the ulcer was performed in one case and showed dermal edema and perivascular, mononuclear infiltrate as the prominent features. We treated the ulcers with oral erythromycin 500 mg QID and prednisolone 0.5 mg/kg per day for 7-10 days and all of them healed with scarring within 10-26 days. The word "chikungunya" is derived from the description in Swahili of the contorted posture of patients afflicted with the severe joint pain associated with this disease. [6] Additional dermatological manifestations reported in recent outbreaks of Chikungunya fever in Southern India include nasal erythema, freckle-like pigmentation over the centro-facial area, lichenoid eruption and hyperpigmentation in sun-exposed areas, lymphedema in acral distribution, multiple ecchymotic spots, vesico-bullous lesions and urticaria. [6]

These types of cutaneous ulcers at the peno-scrotal junction and on the scrotum have never been reported in published literature before. However, similar findings were reported unpublished observations from India. [5] We believe that clinicians should be aware of this picture, as these lesions are self-limiting and usually heal with antibiotics and oral steroids.

Although none of the patients discussed here were tested for the arboviral infection, the clinical picture of fever and joint pain was very typical of chikungunya. Although most of these patients had received non-steroidal anti-inflammatory drugs (NSAIDs) for joint pains these ulcers did not appear to be drug-induced fixed drug eruption or Stevens Johnson syndrome. The peno-scrotal ulcers probably represent a reaction pattern in this type of viral illness which has, to the best of our knowledge, never been published in literature.

References
1.
Chikungunya fever, National Vector Borne Disease Control Programme. Available from: http://www.nvbdcp.gov.in/Doc/Facts%20about%20Chikungunya17806.pdf [Last accessed 2008 May 15]
[Google Scholar]
2.
Update: Chikungunya fever diagnosed among international travelers-United states, 2006. JAMA 2007;297:1976-8.
[Google Scholar]
3.
Robinson MC. An epidemic of virus disease in Southern province Tanganjiki Territory in 1952-53. Trans R Soc Trop med Hyg 1955;49:28-3.
[Google Scholar]
4.
Ananthnarayan R. In: Ananthnarayan R, Jayaram Paniker CK, editors. Textbook of Microbiology. 2nd ed. Madras: Orient Longman; 1985. p. 489-94.
[Google Scholar]
5.
Gosavi R. Skin manifestations after chikungunya. Available from: http://www.doctorndtv.com/shareExp/read.asp?pollid=14&id=1579 (India). [last updated on 2006 Aug 10], [last accessed on 2008 May 15].
[Google Scholar]
6.
Inamadar AC, Palit A, Sampagavi VV, Raghunath S, Deshmukh NS. Cutaneous manifestations of chikungunya fever: Observations made during a recent outbreak in south India. Int J Dermatol 2008;47:154-9.
[Google Scholar]

Fulltext Views
310

PDF downloads
84
Show Sections