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 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.