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 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.