A 48-year-old male presented to his primary care physician with fever, pruritic rash, conjunctivitis, and joint pain for four days. Three days before the onset of symptoms, he returned with his wife (see Case 7 below) from a 12-day trip to Saint Martin and Saint Barthélemy: territories with known vector-borne ZIKV transmission []. The patient denied sexual contact with anybody who had “recently returned from a country where Zika has been spreading.” RT-PCR for ZIKV RNA in serum and urine as well as Zika IgM ELISA in serum were all positive. The patient was not tested for dengue or chikungunya virus.
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.