Clinical and magnetic resonance imaging patterns of extensive Chikungunya virus-associated myelitis

Chikungunya fever is an arbovirus infection transmitted by the same mosquito vector of dengue and Zika virus. Besides high fever, common clinical symptoms include articular pain and general malaise. Neurological involvement is unusual, but some patients may develop peripheral and central nervous system involvement, including meningoencephalitis, myelitis, Guillain-Barre syndrome, and acute disseminated encephalomyelitis. We present three cases of Chikungunya fever complicated with extensive myelitis. The spinal cord magnetic resonance imaging (MRI) pattern is characterized by multiple dotted-like and longitudinal hyperintense lesions, with contrast enhancement, mostly distributed in the peripheral regions of the spinal cord. It seems that these lesions are mostly located in the perivascular spaces (PVS), related or not to virus attack. Involvement of brain PVS can also be demonstrated, as shown in two of the cases described. Considering the MRI pattern, extensive spinal cord lesion should include Chikungunya as a differential diagnosis, especially during an outbreak.

Automated summary

Chikungunya fever is a viral infection transmitted by mosquito vectors, with symptoms including high fever, joint pain, and malaise. Rare cases may involve the nervous system, leading to severe myelitis. MRI findings in affected patients typically show hyperintense lesions with contrast enhancement in the spinal cord, indicating the need for Chikungunya to be considered as a differential diagnosis, especially during outbreaks.