Introduction

Chikungunya Virus (CHIKV) is an arthropod-borne virus that recently spread out of its usual endemic area with an outbreak in Latin America especially in Brazil. However, Horner syndrome has not been reported associated with CHIKV. In this paper we report an infant with CHIKV infection who developed Horner syndrome.

Case report

On January, 2018, a 2-months-old female, was admitted with high-grade fever and rash for 5 days. The infant presented with a compromised general condition, irritability and altered sensorium. In the 4th day of hospitalization showed anisocoric pupils, myosis and ipsilateral ptosis. Magnetic resonance angiography showed no flow in the cervical and intra-cavernous portions of the left internal carotid artery; recanalization of the supra-cavernous portion of the carotid artery and accentuation of the cerebrospinal fluid spaces surrounding the carotid arteries were observed. IgM ELISA for CHIKV was positive in serum and cerebrospinal fluid. The infant was discharged at the tenth day of hospitalization. He still continued to present ptosis and myosis.

Discussion

To the best of our knowledge this is the first report of the association of CHIKV infection with Horner syndrome. We admitted that a vasculitis caused by the CHIKV infection lead to Horner syndrome. Central nervous system vasculitis  (CNS) was described previously in a patient with concomitant infection with CHIKV, Zika virus and dengue virus.

In conclusion CHIKV infection may be associated with Horner syndrome in infants, possibly leading to CNS vasculitis.