Chikungunya-Associated Acute Respiratory Distress Syndrome: A Rare Fatal Case

Chikungunya fever is an arboviral disease caused by an alphavirus belonging to the family Togaviridae. It commonly presents with fever, severe arthralgia, rash, and myalgia, while severe pulmonary involvement causing acute respiratory distress syndrome (ARDS) is rare. We report a 62-year-old man with obesity, diabetes mellitus, hypertension, obstructive sleep apnoea, coronary artery disease, and interstitial lung disease, who presented with high-grade fever, severe arthralgia, facial puffiness, and rapidly progressive dyspnoea, following recent travel to Lucknow, India. On admission, he had severe hypoxemia with a PaO₂/FiO₂ ratio below 100, requiring mechanical ventilation. During intubation, he developed cardiac arrest but achieved return of spontaneous circulation after cardiopulmonary resuscitation. Chikungunya IgM and reverse transcriptase polymerase chain reaction (RT-PCR) were positive. Chest imaging showed diffuse bilateral infiltrates and ground-glass opacities consistent with severe ARDS. Dengue, malaria, and scrub typhus were excluded. The patient was managed with lung-protective ventilation, prone positioning, and corticosteroids according to the Meduri protocol with transient improvement. However, he later developed worsening respiratory failure and multiorgan dysfunction and eventually succumbed after 41 days of hospitalization. Although chikungunya is not typically considered a respiratory virus, clinicians should recognize that severe pulmonary manifestations, including ARDS, may occur, particularly in elderly patients with significant comorbidities.