She was a 30 year old housewife. She was literally carried in to my consulting room by her husband and her mother. She was writhing with agony at each movement of her joints.
She was perfectly all right in the morning.She walked down to the river[which was about 1/2 kilometre away] to bath, came back and made coffee.At that moment,before she could serve coffee her joint pain started with shivering and she had to be carried from kitchen to bedroom.
She had pain in small joints of fingers, wrist,elbow, shoulders,hip,knee and ankles. All those joints were warm. Her temperature was 101F. Rest of the examination was normal.
Yes, this is the classical onset of Chikungunya fever. I send her out in a wheel chair to get admitted.She was given medicines to reduce fever and inflammation of joints.The next day she was sitting happily ready to go home. Her fever has subsided and joint pains less.She will continue to suffer from joint pains for uncertain number of weeks, and thus may need to continue anti inflammatory drugs.
The fever and joint pains in chikungunya infection start so suddenly that some patients are able to tell the exact minute of onset. I still wonder why the onset is so sudden and unexpected.