From the Journals

Chikungunya infection in children masquerades as SJS-TEN


Key clinical point: Chikungunya fever in children may present with skin symptoms similar to Stevens-Johnson syndrome and toxic epidermal necrolysis.

Major finding: Of 21 children with chikungunya, 76% had developed vesicles and bullae with purpuric macules and necrosis.

Study details: A case series of 21 children with chikungunya fever in India.

Disclosures: The researchers had no financial conflicts to disclose.

Source: Garg T et al. Pediatr Dermatol. 2018 Mar 24. doi: 10.1111/pde.13450.



Chikungunya infections in young children resemble skin symptoms characteristic of Stevens-Johnson syndrome and toxic epidermal necrolysis, (SJS-TEN), according to data from a case series of 21 children seen during a chikungunya outbreak in India in August and September 2016.

Shown is the Chikungunya virus. CDC/Cynthia Goldsmith

Shown is the Chikungunya virus.

“Cutaneous involvement in chikungunya is seen in 40%-75% of patients,” having varied presentations, wrote Taru Garg, MD, and colleagues at the Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. Chikungunya mimicking SJS-TEN is rare: 96 cases have been reported in the literature, to the investigators’ knowledge.

The researchers described their observations of 13 boys and eight girls aged 1-36 months in Pediatric Dermatology. All 21 children presented with vesiculobullous and necrotic lesions and mild to moderate fever; 16 children (76%) had large erosions, purpuric macules, and necrosis. Most of the lesions occurred on the extremities.

The time from the onset of illness to presentation ranged from 1 to 9 days, and the skin lesions resolved in 5-7 days. The lesions resolved with no sequelae in 11 patients, with hyperpigmentation in seven (33%) , and with hypopigmentation in three patients (14%).

In addition, three patients (14%) developed minor oral erosions, and four (19%) developed palmoplantar erythema, which also may be associated with SJS-TEN. However, none of the patients experienced the severe mucositis and ocular and genital involvement common to SJS-TEN, Dr. Garg and associates noted. A total of seven children tested positive for chikungunya based on enzyme-linked immunosorbent assay results.

Severity of illness can be helpful to distinguish chikungunya from SJS-TEN, the researchers said. Based on the Nelson severity index, 11 children in this series met the criteria for “not sick,” nine were “moderately sick,” and one was “very sick.”

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