Chikungunya virus (CHIKV) fever is an arboviral infection which commonly presents as an acute febrile syndrome with arthralgias. In Brazil, CHIKV outbreak occurred recently.

Case 1: A 50-year-old man attends the emergency room with a 10 days history of numbness in hands and feet. He reported that 1 month before he had an acute picture of fever, arthralgias, edema of hands and itchy rash in the trunk, received a clinical diagnosis of Chikungunya virus (CHIKV) infection, without however performing any complementary tests. On our evaluation, his neurological examination showed right complete peripheral facial paresis, with concomitant weakness of the left orbicularis eye muscle, globally hypoactive reflexes, tactile and painful hypoaesthesia to the knees and elbows, and distal hypopalasthesia in legs.

Case 2: A 56-year-old man presented with an acute onset of rash, arthralgia, myalgia and fever. He was initially treated with symptomatic medications. After 14 days, he kept only arthralgia, noticed difficulty to close his eyes and rapidly evolved with eating difficulty, being unable to keep food in his mouth, and with burning and freezing sensations in his feet, specially during the night. In the emergency room, his neurologic examination showed bilateral facial paralysis, global areflexia and a burning sensation in feet.

In both cases, CSF analysis showed albuminocytological dissociation and positive CHIKV IgM serology with negative PCRs.  Other serology for other arboviruses (dengue and zika) and other diseases (HIV, toxoplasmosis, syphilis, cytomegalovirus, hepatitis A, B and C and HTLV) were negative. Electroneuromyograms revealed a demyelinating process.  Immunoglobulin treatment was instituted and both patients showed a good response.

Despite the rarity of the facial diplegia variant with paresthesias, due to its severity and the increasing incidence of arboviruses, especially CHIKV, we emphasize the importance of these cases.