A middle aged gentleman presented with complaints of pyrexia and severe body ache since about 4 days. He also noticed popular rash over both lower limbs during the illness. He did not have cough, urinary or bowel complaints. He was treated with antibiotics and antipyretics from local doctors. The fever didn't respond during first 4 days of oral treatment.
He had been diagnosed as NIDDM earlier and on regular OHA. No history other medical or surgical co morbidities in the past.
Examination revealed fever with maculo-papular rash over both lower limbs. No other localizing signs were noted. The systemic examination was unremarkable.
He was started on Inj. Ceftriaxone, T. Azithromycin , Cap Maligon (stat) and antipyretics and the blood investigation were planed meanwhile. CBC revealed mild leucopenia with mild thrombocytopenia and other investigations were unremarkable.
However he continued to have fever and severe myalgia. Further he was investigated for malaria, dengue, enteric fever and a blood and urine culture was sent. The investigations including CXR & USG Abdomen-pelvis were too unremarkable except pus cells in urine.
The treatment was continued with antibiotics (changed with ceftazidime, G/M, Levoflox), antipyretics, IV fluids and oral artisunate. The rash disappeared by 4 days, the fever and myalgia continued for 5 days. On day 6, the afebrile spell of 24 hrs was noted. The platelet count was recovered to normal limits. The OHA were stopped during the treatment period and was monitored for glycemic control.
Although the illness simulated as classical PUO, the possibility of a viral illness like Dengue/CHIKUNGUNYA needs to be confirmed.