A 33-year old female presented to the emergency department complaining of a gradually worsening rash localized to her chest, neck, and right side of her face for two days. Associated symptoms were fatigue, sore throat, nasal congestion, “itchy, red, watery eyes,” and myalgia. She denied fever, chills, and arthralgia. She had returned to the United States from the Dominican Republic one week prior, but she did not recall being bitten by a mosquito. She reported that her son had a positive test for ZIKV. On physical exam, the patient was afebrile and hemodynamically stable. She had an erythematous posterior pharynx and a trace fine papular rash on the chest, neck, and right face. Blood chemistry tests were all within normal limits. Hematologic tests showed mild anemia (hemoglobin 11.9 g/dL, normal range: 12.0–16.0 g/dL), mildly increased lymphocyte percentage (44.0%, normal range: 23.0–43.0%), and mildly increased monocyte percentage (10.7%, normal range: 0.0–10.0%). RT-PCR for ZIKV RNA was positive in urine and negative in serum. The patient was not tested for chikungunya or dengue virus infections. The ZIKV blood and urine samples were analyzed at an offsite laboratory; therefore, the results were not available at the time of discharge. A pregnancy test was negative. The patient was treated with one dose of each of the following medications: diphenhydramine 25 mg IV, acetaminophen 975 mg IV, and ondansetron 4 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.