A 56-year-old male presented to the emergency department complaining of fever, joint pain, and a generalized rash for three days. He denied headache or ocular complaints. He denied any recent travel. The patient works outdoors at a hotel in the South Beach neighborhood of Miami Beach, Florida, an area known to have active vector-borne transmission of ZIKV at the time of the patient’s presentation []. On physical exam, the patient was afebrile and hemodynamically stable. He had a generalized erythematous maculopapular rash and no other relevant physical findings, including ocular manifestations. Blood urea nitrogen (BUN) and creatinine were elevated (BUN: 23 mg/dL, normal range: 6–22 mg/dL; creatinine: 1.32 mg/dL, normal range: 0.43–1.13 mg/dL). Otherwise, blood chemistry tests were within normal limits. Hematologic tests were all within normal limits. RT-PCR for ZIKV RNA was positive in urine, though the results were not available until after discharge, as the sample was analyzed at an offsite laboratory. Serum was not tested for ZIKV, chikungunya, or dengue viruses. The patient was treated with one dose of ketorolac 30 mg IV. On discharge, the patient was instructed to follow up with his 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.