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 56-year-old female presented to her primary care physician with fever, conjunctivitis, arthralgia, and a rash on her chest, arms, and neck. She reported recent travel to Jamaica. History regarding trip duration and timing relative to symptom onset is not available. Body fluid samples were collected, and RT-PCR for ZIKV RNA was positive in urine and negative in serum. Serum RT-PCR RNA for dengue virus was negative. Serology for dengue virus was negative for IgM and positive for IgG. Serum RT-PCR for chikungunya virus RNA was negative.