The patient is a woman in her early 30s who sought medical care in Missouri after recent travel to Haiti for a one-week missionary trip. Three days after returning she had a fever, myalgia, and arthralgia. Tests for dengue and chikungunya virus were performed and were positive for dengue IgG, and negative for dengue IgM antibodies. Both IgM and IgG antibodies tests were negative for the chikungunya virus. The patient was diagnosed with dengue fever and placed on bed rest with acetaminophen.
After 3 weeks the patient still had joint pain in her hands and feet. Repeat laboratory tests for dengue and chikungunya were performed. This time tests were positive for chikungunya IgM and IgG antibodies. Dengue IgM and IgG antibodies were negative. She was referred to a rheumatologist for pain management.
This case points out the difficulty in diagnosing both chikungunya and dengue infections.
