A neonate born to a mother with fever for
a week prior to delivery was admitted with respiratory
distress, and was treated with intravenous antibiotics for
suspected sepsis. He developed marked hyperpigmentation over
the face (Fig. 1) associated with worsening
thrombocytopenia during the first week of life. This
classical hyperpigmen-tation (brownie-nose appearance)
suggested the possibility of neonatal chikungunya, which was
confirmed by positive IgM antibodies to chikungunya in both
the mother and baby. The platelet count gradually normalized
and baby was discharged on day 10 of life.
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Fig. 1 Brownie nose
appearance in neonatal chikungunya.
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Vertical transmission of Chikungunya,
though rare, is well described with the maximum risk if the
mother is viremic at delivery. Neonatal chikungunya is
manifested by neurological, dermatological, ocular, renal
and hemato-logical involvement. Maculopapular and
vesicolobullous rash, and striking hyperpigmentation are the
common dermatological manifestations. Differential diagnoses
include congenital lupus, drug rash (eg. imipenem), and
bacterial (Listeria, S. epidermidis), fungal
(Candida) and viral (human herpes virus 6, enterovirus)
infections.
