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 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.