Atypical clinical presentation of chikungunya fever in critical care

Chikungunya virus is an Alphavirus, it belongs to the family Togaviridae and is transmitted by mos-quitoes. It was first described during an outbreak in Southern Tanzania in 1952. It generally causes a febrile syndrome, accompanied by joint pain and arthritis, which is often debilitating and may persist for months or years. Its overall fatality rate is not high, around 0.1%. Atypical and severe cases have been reported. This virus has been detected in more than 110 countries globally. In Northeastern Brazil autochthonous cases have been diagnosed since September 2014. In Argentina, as well as in neighboring countries, cases were increasing during 2023, compared to the same periods in previous years. Until epidemiological week 26 of 2023, 1460 cases of chikungunya fever were reported in Argentina, 72% of them were considered of autochthonous transmission. The case of a 76-year-old female patient is here presented, her comorbidities were hypertension and aortic stenosis, who was admitted to intensive care unit due to septic shock with respiratory focus, interstitial pneumonia in X-ray pattern, and torpid evolution. She died within 24 hours of admission. A report of detectable Chikungunya virus by real-time polymerase chain reaction in real time was received post-mortem. This case results of clinical relevance due to its atypical presentation and the country low prevalence of severe infections by this virus. It warns of the need to include the differential diagnosis in cases with sus-pected diagnosis.