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.

“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.”

It is key “to be aware of SJS-TEN–like presentation of chikungunya and not to misinterpret it as true SJS-TEN, which will lead to unnecessary intervention and management,” Dr. Garg and associates said.

The researchers had no financial conflicts to disclose.

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

Chikungunya infection in children masquerades as SJS-TEN