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Indian Pediatr 2014;51: 419

Brownie-nose: Hyperpigmentation in Neonatal Chikungunya

Naresh Kumar, Vijay Gupta and Niranjan Thomas

Department of Neonatology, CMC Vellore, Tamil Nadu, India.
Email: niranjan@cmcvellore.ac.in


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.

Fig. 1 Brownie nose appearance in neonatal chikungunya.

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.


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