Image based Case Discussion: 30/05/2026

General
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A 12-day-old male baby born to a 27-year-old primigravidae mother at 38 + 2 weeks gestation via cesarean section presented with complaints of fever, poor feeding, and excessive crying for 4 days. In addition, parents noticed increasing facial hyperpigmentation. No history of maternal fever or any other antenatal complications were reported. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Birth weight was 2.76 Kg. The baby was discharged on breastfeeds
on day 3 of life. On 8th day of life, infant developed fever, poor feeding, excessive crying, and facial hyperpigmentation.
At admission, baby was febrile (temp. 100.1F/37.8°C), irritable, and had hyperpigmentation of face.

Prompting questions for discussion:

  • Most likely diagnosis and the specific sign associated/pathognomic: what feature in the image supports diagnosis?
  • Key differentials for neonatal hyperpigmentation with recent maternal febrile exanthem?
  • What bedside clues help separate these?
  • What initial workup would you prioritize?

image
image331×386 47.1 KB

MBH/DB

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@DeepikaBishnoi good one is think it’s chikungunya symptoms fever, pigmentation, poor feeding, brownie nose.

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The most likely diagnosis is congenital Chikungunya infection. The characteristic facial hyperpigmentation along with fever, irritability, poor feeding, and a history suggestive of maternal febrile illness support the diagnosis. Initial evaluation should focus on ruling out neonatal sepsis while investigating for congenital Chikungunya through appropriate laboratory testing.