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Abstract

Chikungunya virus is a mosquito-borne alphavirus that typically causes acute infection, characterized by the abrupt onset of fever, polyarthralgia, sore throat, conjunctivitis, and cutaneous manifestations. Morbilliform eruption is the most common cutaneous manifestation; however, varied clinical morphologies have been described. Although cutaneous manifestations have been reported in up to 75% of cases, histopathologic descriptions remain limited. Herein, we describe the histopathologic findings in a case of acute chikungunya infection. A 33-year-old woman with no significant past medical history presented with a rapidly progressive pruritic rash involving the extremities and trunk, which began during travel to Madagascar. She denied having a fever but reported experiencing polyarthralgia and a recent mosquito bite. Physical examination revealed an erythematous maculopapular eruption coalescing into plaques, diffusely distributed across the upper and lower extremities, including palms and soles. A punch biopsy from affected skin demonstrated numerous dyskeratotic keratinocytes at all levels of the epidermis, with prominent involvement of the superficial layers and foci of superficial epidermal necrosis. Subtle basal vacuolization was present. Dyskeratosis was also noted in the sebaceous gland epithelium. Subsequent serologic testing confirmed acute chikungunya virus infection with positive IgM and IgG antibodies. Recognition of these histopathologic features, particularly in returning international travelers, may prompt consideration of additional laboratory testing and expand the documented spectrum of chikungunya-associated histopathology.