Chikungunya Virus Infection Presenting with Persistent Arthralgia without Fever

Chikungunya virus infection (CVI) typically manifests via a "two-phase" presentation: most patients develop acute fever and some patients subsequently develop arthralgia that can persist for years. Many patients visit clinics during the second phase, for relief of the arthralgia, but not during the acute febrile phase. We report a 25-year-old Japanese man infected with CVI in Jamaica who presented with chronic disabling peripheral-dominant symmetric polyarthralgia without fever, which affected the neck, knees, elbows, wrists, and fingers. Given the recent emergence of dengue fever in Japan, clinicians should consider CVI as a differential diagnosis of dengue fever when examining travelers complaining of persistent arthralgia, regardless of their countries of origin.