A 28-year-old female presented to the emergency department complaining of fever, generalized rash, arthralgia, and myalgia. She denied any headache or ocular complaints. She recently traveled to the Dominican Republic where she described having been bitten by mosquitos. History regarding trip duration and timing relative to symptom onset is not available. On physical exam, the patient was afebrile and hemodynamically stable. She had a generalized maculopapular rash and no other relevant physical exam findings, including ocular manifestations. Blood chemistry tests were all within normal limits. Hematologic tests showed very mildly increased monocyte percentage (10.8%, normal range: 0.0–10.0%) with a normal white blood cell count. Laboratory findings were positive for RT-PCR for ZIKV RNA in urine and negative in serum. Chikungunya (IgM and Immunoglobulin G [IgG]) and dengue (IgM) virus serology were negative. Body fluid samples were analyzed at an offsite laboratory; therefore, the results were not available until after discharge. A pregnancy test was negative. The patient was treated with one dose of each of the following medications: morphine 2 mg IV, ondansetron 4 mg IV, and methylprednisolone 80 mg IV. She was also given 1 L of normal saline IV. On discharge, the patient was instructed to follow up with her primary care physician.
A 17-year-old male presented to the emergency department due to his father’s concern that the patient was infected with ZIKV. He had no complaints or symptoms at the time of the visit. The patient reported experiencing joint pain, pruritic generalized rash, headache, and fever on the previous day. He denied any ocular complaints. He had returned from Puerto Rico on the previous day. While in Puerto Rico, he was in contact with a friend who experienced the same symptoms. Per the patient, the friend’s physician told him he had a viral condition. On physical exam, he was afebrile and hemodynamically stable. There were no positive relevant findings on physical exam. Blood chemistry tests were all within normal limits. Hematologic tests showed a mildly decreased white blood cell count (3.1 × 103/mL, normal range: 4.5–13.5 × 103/mL) and a mildly increased hemoglobin (15.3 g/dL, normal range: 11.0–15.0 g/dL) and hematocrit (43.7%, 33.0–43.0%). Lymphocyte percentage was decreased (0.9 × 103/µL, normal range: 1.2–6.4 × 103/µL). RT-PCR for ZIKV RNA was positive in urine and negative in serum. Serology was positive for dengue virus (IgM positive, IgG negative) and negative for chikungunya virus (IgM and IgG negative). Body fluid samples were analyzed at an offsite laboratory; therefore, the results were not available at the time of discharge. The patient received no treatment during this visit. On discharge, the patient was instructed to follow up with his primary care physician and to avoid sexual contact.