ABC | Volume 114, Nº4, Suplement, April 2020

Case Report Athayde et al Heart Failure and Chikungunya Fever Arq Bras Cardiol 2020; 114(4Suppl.1):19-22 of tramadol, and, the following day, laboratory exams revealed thrombocytopenia (drop from 135,000 to 87,000 per mm 3 in 5 days, Table 1). The arthralgia and thrombocytopenia led to clinical suspicion of arbovirus, and serology was thus requested for dengue and chikungunya. The patient progressed with worsened peripheral and central congestion, with lower limb edema (3+/4+), jugular venous distention, hepatojugular reflux, bibasilar crackles, and square-wave systolic blood pressure response to the Valsalva maneuver. There were no signs of hypoperfusion, and the patient was again classified as hemodynamic profile B, and intravenous diuretic therapy was reinitiated. On the fourteenth day of hospitalization, the thrombocytopenia, arthralgia, and pattern of congestion (returning to hemodynamic profile A) improved. Laboratory exams did not reveal electrolytic disorders (Table 1) or alterations in liver function. The blood tests for chikungunya fever were positive (IgG and IgM). Thus, full anticoagulation with apixaban was reinitiated, and regular analgesia was changed to only if necessary. Throughout the entire hospitalization, the electrocardiographic pattern was maintained. The following day, the patient remained stable, maintaining a dry-warm hemodynamic profile, and he was discharged from the hospital with the following prescription: furosemide (40 mg, twice daily, carvedilol (25 mg, twice daily), atorvastatin (20 mg daily), formoterol + budesonide (12/400 mcg, twice daily), allopurinol (100 mg daily), apixaban (5 mg, twice daily). There were no new episodes of clinical decompensation during the three months following hospital discharge. Figure 1 – Case report timeline Table 1 – Laboratory results during hospitalization Laboratory exams Day of hospitalization 1 3 5 12 14 C-reactive protein (mg/dL) 3.00 2.90 2.56 10.60 10.30 Urea (mg/dL) 96 148 102 72 107 Potassium (mEq/L) 6.3 5.8 3.5 4.6 4.6 Creatinine (mg/dL) 2.0 3.6 2.2 1.6 1.9 Hemoglobin (g%) 14.9 16.3 14.0 14.1 13.0 Leukocytes (mil/mm 3 ) 6.9 7.9 5.7 8.7 5.7 Platelets (mil/mm 3 ) 106 135 87 80 111 Man, 71-year-old Heart failure with reduced ejection fraction + atrial fibrillation Acute decompensated heart failure Days of hospitalization (DOH) 1 st DOH Hemodynamic profile B No triggers identified 4 th DOH Macrocospic hematuria Thrombocytopenia (80.000/mm 3 ) 7 th DOH Incapacitating arthralgia Joint swelling Worsening of congestion Diuretic infusion Suspension of anticoagulants Intensification of diuretic therapy (furosemide) Tramadol 9 th DOH Positive serologies for Chikungunya virus (IgM and IgG) 14 th DOH No hematuria or arthralgia Hemodynamic profile A 16th DOH: Hospital discharge Figure: Case report timeline Hemodynamic profile B A A B 20