Severe bullous skin lesions associated with Chikungunya virus infection in small infants.

INTRODUCTION: The aim of this study was to describe a pediatric case series of Chikungunya infection associated with extensive bullous skin lesions, a severe and unknown form of the disease, during the 2005-2006 outbreak in La Réunion Island.

MATERIALS AND METHODS: Retrospective descriptive hospital-based study in children presenting blisters > or = 10% of total body surface area with laboratory-confirmed Chikungunya infection.

RESULTS: Eight boys and five girls with a mean age of 3.4 months were included. Blistering began after an average of 2 days after onset of fever and affected 21.5% (10% to 35%) of the total body surface area. Reverse transcription-polymerase chain reaction of blister fluid (n = 5) was positive with a mean viral load sometimes higher than in concurrent serum. Histopathologic examination (n = 10) showed intraepidermal blisters. Hospitalization and repeated dressing changes under general anesthesia were required. No death occurred. On follow-up, long term repigmentation was excellent with sometimes cosmetic sequelae.

CONCLUSION: Chikungunya should be included in the differential diagnosis of febrile blistering dermatoses in small infants in epidemic areas.