Parsonage-Turner syndrome following chikungunya virus infection:A case report

Rationale: Parsonage-Turner syndrome is a rare syndrome of unknown etiology, affecting mainly the lower motor neurons of the brachial plexus.Chikungunya fever is a mosquito-borne viral disease characterized by acute fever and polyarthritis/polyarthralgia.Patient concerns: A 54-year-old Brazilian male patient who presented with a 2-day history of fever(temperature 38.8 ℃), arthralgia, erythematous rash, diffuse osteomuscular pain and headache, which evolved into left shoulder pain associated with morning stiffness.Diagnosis: Parsonage-Turner syndrome and chikungunya fever.Interventions: Symptomatic treatment(a combination of short-acting dypirone(500 mg every 6 h) and slow-release opioids(tramadol 100 mg every 4 h) and physiotherapy/rehabilitation with improvement.Outcomes: The patient was improved and discharged, remaining with symptomatic treatment and physiotherapy/rehabilitation.Lessons: To the best of our knowledge, there were no reports of Parsonage-Turner syndrome following chikungunya virus infection.Awareness of the possibility of this rare association is important.The present case report highlights the importance of awareness of this association as a new cause of morbidity in patients with chikungunya virus infection.

Clinical outcomes of hospitalized patients with chikungunya fever: A retrospective analysis

Objective:To describe the prognostic and clinical profile of hospitalized patients with chikungunya virus(CHIKV)infection focusing on renal outcomes.Methods:This is a cross-sectional study including all patients with confirmed chikungunya fever(CHIKF)admitted to 3 different highcomplexity hospitals in Fortaleza,Brazil between January 2016 and June 2017.Data analysis was carried out to evaluate correlation between clinical profile and outcomes.Results:Fifty-five patients were included,with a median age of 77(IQR=21)years,and 23(41.82%)were male.Twenty-five patients(45.45%,25/55)developed acute kidney injury(AKI),and 15(60.00%,15/25)were classified as KDIGO 1,1(4.00%)as KDIGO 2,and 9(36.00%)as KDIGO 3.The overall mortality was 34.54%whilst AKI-related mortality was 64.00%(16/25).Both AKI and encephalitis were associated with higher mortality.Patients who died were significantly older[82(IQR=12)years vs.70(IQR=28.75)years,P<0.001].In the multivariate analysis,abdominal pain was associated with an increased risk of severe AKI(OR=5.33,95%CI=1.11–25.64,P=0.037)and AKI was an independent risk factor of death(OR=12.06,95%CI=2.55–57.15,P=0.002).Recovery of renal function was similar among the different age groups.Conclusions:AKI is present in half of the study population and is an independent risk factor of death.Thus,renal function should be carefully monitored in hospitalized patients with CHIKV infection.

Acute kidney injury in leptospirosis:Overview and perspectives

Leptospirosis is a bacterial disease disseminated through the centuries in the whole world which causes symptoms that go from self-limited diseases to hemorrhagic manifestations and organ failure, including acute kidney injury(AKI), composing the severe disease known as the Weil's syndrome. Mortality rates varies according to the clinical presentation and usually increases when kidney injury is present, and is even higher in the setting of pulmonary hemorrhage. There are recent advances in the search for novel biomarkers of renal involvement and early detection of AKI in leptospirosis, as well as in its pathophysiology. We review in this article the clinical aspects of leptospirosis-associated AKI and the perspectives for future research.