{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T17:11:14Z","timestamp":1755796274440,"version":"3.44.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T00:00:00Z","timestamp":1755475200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Myeloneuropathy is rare complication of Chikungunya virus (CHIKV) infection which may have an underlying immune-mediated pathogenesis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We describe a 31-year old female patient with systemic lupus erythematosus (SLE) presenting with acute\/hyperacute bulbar and medullary fever syndrome with ascending tetraparesis associated with arthritis, requiring differential diagnosis. The analysis of the cerebrospinal fluid (CSF) revealed inflammatory markers, high protein levels, high lymphocyte and neutrophil counts, and reduced glucose. Neuroimaging showed amorphous foci of hyperintensity in T2, suggesting extensive medullary edema, especially in the central region, with no significant contrast enhancement, along with areas of medullary atrophy consistent with holocord longitudinally extensive transverse myelitis and periventricular and periaqueductal involvement. CHIKV IgM antibodies were also detected in the CSF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The present case highlights the importance of investigating atypical neurological syndromes in SLE and of including CHIKV infection, though rare, in the differential diagnosis of patients from endemic regions in order to minimize morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1600806","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:27:54Z","timestamp":1755494874000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinally extensive transverse myelitis as a manifestation of neuro-chikungunya in a lupus patient: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Emanuelle de Matos","family":"Rodrigues","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lysiane Maria Adeodato Ramos","family":"Fontenelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Rocha de Saboia","family":"MontAlverne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirla Wagner Poti","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia Ara\u00fajo de Sousa","family":"Studart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beatriz Rodrigues","family":"Neri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Ewerton Maia","family":"Rodrigues","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"ITC81","DOI":"10.7326\/AITC202006020","article-title":"Systemic lupus erythematosus","volume":"172","author":"Kiriakidou","year":"2020","journal-title":"Ann Intern Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1038\/s41584-024-01163-z","article-title":"Recent advances in the diagnosis and management of neuropsychiatric lupus","volume":"20","author":"Legge","year":"2024","journal-title":"Nat Rev Rheumatol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e231745","DOI":"10.1136\/bcr-2019-231745","article-title":"Longitudinally extensive transverse myelitis with seropositive chikungunya","volume":"12","author":"Hameed","year":"2019","journal-title":"BMJ Case Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1002\/1529-0131(199904)42:4<599::AID-ANR2>3.0.CO;2-F","article-title":"The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes","volume":"42","author":"Liang","year":"1999","journal-title":"Arthritis Rheum"},{"key":"B5","doi-asserted-by":"publisher","first-page":"104938","DOI":"10.1016\/j.idnow.2024.104938","article-title":"A meta-analysis of Chikungunya virus in neurological disorders","volume":"54","author":"Costa","year":"2024","journal-title":"Infect Dis Now."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e2017127","DOI":"10.5123\/S1679-49742018000300003","article-title":"Chikungunya surveillance in Brazil: challenges in the context of Public Health","volume":"27","author":"Silva","year":"2018","journal-title":"Epidemiol Serv Saude."},{"key":"B7","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1007\/s13365-021-00962-4","article-title":"Clinical and magnetic resonance imaging patterns of extensive Chikungunya virus-associated myelitis","volume":"27","author":"Rueda-Lopes","year":"2021","journal-title":"J Neurovirol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"117279","DOI":"10.1016\/j.jns.2020.117279","article-title":"Chikungunya encephalitis, a case series from an endemic country","volume":"420","author":"Ortiz-Quezada","year":"2021","journal-title":"J Neurol Sci."},{"key":"B9","unstructured":"Staples\n              JE\n            \n            \n              Hills\n              S\n            \n            \n              Powers\n              A\n            \n          \n          Chikungunya. CDC Yellow Book.\n          \n          2024"},{"key":"B10","doi-asserted-by":"publisher","first-page":"207","DOI":"10.4103\/0974-777X.103898","article-title":"Chikungunya myeloradiculopathy: a rare complication","volume":"4","author":"Krishnan","year":"2012","journal-title":"J Glob Infect Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1136\/annrheumdis-2018-214819","article-title":"2019 European league against rheumatism\/American College of Rheumatology classification criteria for systemic lupus erythematosus","volume":"78","author":"Aringer","year":"2019","journal-title":"Ann Rheum Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"177","DOI":"10.4103\/0028-3886.51289","article-title":"Neurological complications of Chikungunya virus infection","volume":"57","author":"Chandak","year":"2009","journal-title":"Neurol India."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e1978","DOI":"10.1002\/rmv.1978","article-title":"The neurological complications of chikungunya virus: a systematic review","volume":"28","author":"Mehta","year":"2018","journal-title":"Rev Med Virol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"69","DOI":"10.22278\/2318-2660.2022.v46.nSupl_1.a3785","article-title":"Mielopatias inflamat\u00f3rias","volume":"46","author":"Barreto","year":"2022","journal-title":"RBSP"},{"key":"B15","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.virusres.2011.12.009","article-title":"Characterization of Chikungunya virus infection in human neuroblastoma SH-SY5Y cells: role of apoptosis in neuronal cell death","volume":"163","author":"Dhanwani","year":"2012","journal-title":"Virus Res."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e04312019","DOI":"10.1590\/0037-8682-0431-2019","article-title":"Events preceding death among chikungunya virus infected patients: a systematic review","volume":"53","author":"Cerbino-Neto","year":"2020","journal-title":"Rev Soc Bras Med Trop."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1636","DOI":"10.3174\/ajnr.A1133","article-title":"Chikungunya encephalomyeloradiculitis: report of 2 cases with neuroimaging and 1 case with autopsy findings","volume":"29","author":"Ganesan","year":"2008","journal-title":"AJNR Am J Neuroradiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"OD19","DOI":"10.7860\/JCDR\/2016\/13095.7777","article-title":"An unusual case of myelitis with myositis","volume":"10","author":"Choudhary","year":"2016","journal-title":"J Clin Diagn Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s13365-015-0372-9","article-title":"Myeloradiculopathy associated with chikungunya virus infection","volume":"22","author":"Bank","year":"2016","journal-title":"J Neurovirol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1212\/WNL.0000000000206759","article-title":"\u201cGlass Eel\u201d sign in chikungunya myelopathy","volume":"100","author":"Nobrega","year":"2023","journal-title":"Neurology."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1007\/s00705-016-2829-4","article-title":"Diagnostic potential of monoclonal antibodies against the capsid protein of chikungunya virus for detection of recent infection","volume":"161","author":"Damle","year":"2016","journal-title":"Arch Virol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e83092","DOI":"10.7759\/cureus.83092","article-title":"A case report of neuromyelitis optica spectrum disorder in a young patient with systemic lupus erythematosus","volume":"17","author":"Audhya","year":"2025","journal-title":"Cureus."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e936283","DOI":"10.12659\/AJCR.936283","article-title":"Systemic lupus erythematous and neuromyelitis optica causing hypercapnic respiratory failure","volume":"23","author":"Dominguez","year":"2022","journal-title":"Am J Case Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s12028-017-0413-8","article-title":"The range of neurological complications in chikungunya fever","volume":"27","author":"Cerny","year":"2017","journal-title":"Neurocrit Care"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1600806\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T05:27:55Z","timestamp":1755494875000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1600806\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,18]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1600806"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1600806","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,8,18]]},"article-number":"1600806"}}