Persistent arthralgias in Ross River virus disease after travel to the South Pacific

History and clinical findings: A 57-year-old patient presented with malaise and severe persistent arthralgia of the left shoulder. He reported an acut e illness with fever, generalized myalgia and arthralgias of the large join ts which had started one month earlier during his flight back to Germany af ter a two weeks trip to the South Pacific. Physical examination showed exte nsive pain on palpation of the glenohumeral and acromioclavicular joints wi th impairment of active and passive mobility. Investigation of the cervical spine was normal. Investigations: Apart from elevated C-reactive protein and erythrocyte sedi mentation rate levels, routine laboratory investigations were normal includ ing negative immunodiagnostic tests for autoantibodies and various global i nfections that may be associated with arthritis. Immunofluorescence tests s howed significant levels of specific IgM- and Igc-antibodies against Ross R iver virus (RRV) but not against other arboviruses endemic in the South Pac ific and Australia (Dengue, West Nile, Chikungunya, Sindbis, Barmah Forest) . This was confirmed by a positive RRV neutralisation test. Attempts at vir us isolation and detection of viral RNA by PCR were not successful. Treatment and course: Symptomatic treatment with high doses of diclofenac q uickly led to pain relief, and arthralgias receded within 10 days after beg in of treatment. However, several bouts of arthralgia of the left shoulder and left knee occurred during a period of 4 months. Conclusions: Because of the current epidemiological situation in the South Pacific and Australia, infections by arboviruses like RRV should be conside red in travellers returning from these areas with severe and persistent art hralgia of unknown origin, even in the absence of fever and other symptoms of acute infection.