[Imported Chikungunya Infection Following Travel to Cuba: A Case with Persistent Inflammatory Arthralgia in the...

Alphavirus chikungunya is an arbovirus transmitted by Aedes mosquitoes and typically presents with acute-onset fever and severe polyarthralgia. In a subset of patients, joint symptoms may persist beyond the acute phase, leading to prolonged functional impairment. With increasing international travel, imported chikungunya infections have become an important consideration in non-endemic countries. In this report, we present a 58-year-old woman who was diagnosed with imported chikungunya infection after returning from Cuba, presenting with fever and widespread joint pain. On initial evaluation, C-reactive protein levels were markedly elevated, while procalcitonin levels remained within normal limits. The diagnosis was confirmed by demonstrating chikungunya virus-specific IgM positivity and IgG seroconversion in sequential serum samples. Viral RNA was not detected in molecular assays. Dengue, Zika, and other arboviral infections, as well as rheumatologic diseases, were excluded during the differential diagnosis. Despite treatment with antipyretics and non-steroidal anti-inflammatory drugs, the patient's joint pain persisted and significantly limited daily activities, necessitating opioid analgesics. Based on the persistence of symptoms beyond the acute phase but for less than three months, the clinical picture was consistent with subacute (post-acute) chikungunya-associated inflammatory arthralgia. Systemic corticosteroid therapy was initiated, resulting in partial clinical improvement. Disease-modifying antirheumatic drugs were not started, as the criteria for chronic chikungunya arthritis were not met. This case highlights the importance of considering chikungunya infection in travelers returning from endemic regions who present with fever and persistent arthralgia, even in the absence of rash. Early recognition and appropriate management during the subacute phase are crucial to improve patient outcomes and prevent progression to chronic disease.