A previously healthy 28-year-old woman from Canada experienced extensive mosquito bites while visiting Mumbai, India, in September 2010. Twelve days into her trip, an acute onset of fever, chills and severe joint pain developed, primarily affecting her wrists, neck and ankles. While in India, she received treatment for presumptive malaria and was given parenteral analgesia. After three days, her fever resolved. In addition to fever and joint pain, she reported skin hyperpigmentation on the bridge of the nose. During her convalescence, there was no recurrence of fever, but she remained unable to extend and rotate her wrists, dorsiflex, plantar flex, or internally or externally rotate her ankles without substantial pain.
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