Certain Skin and Tissue Lesions Point to Zika Virus Infection

By Marilynn Larkin

May 17, 2016

NEW YORK (Reuters Health) - Certain dermatological features coupled with other symptoms signal a likely diagnosis of Zika virus infection, researchers report.

"The mucocutaneous findings of Zika virus infection are not specific. A similar constellation of features may present in patients with other types of viral infections and inflammatory conditions," Dr. Amit Garg of Hofstra Northwell School of Medicine in Hempstead, New York told Reuters Health by email. "Our aim was to provide a more detailed morphologic description of mucocutaneous and tissue findings than exists in the literature, with the goal of improving awareness and recognition of suspected cases by the health care community," he said.

Dr. Garg and colleagues describe their findings in a case report in JAMA Dermatology, online May 11. Their patient, a 44-year-old man, experienced headache and lethargy within three days of returning from a vacation in Puerto Rico. A day later, an erythematous eruption appeared on his arms and hands, eventually spreading to the torso. On examination, the authors found the eruptions to be comprised of red erythematous papules. In addition, the patient's eyes appeared "bloodshot."

Subsequently, the rash faded on the upper body and spread to the lower body. The patient then developed joint pain. Real-time polymerase chain reaction detected Zika virus RNA in the urine but not in serum samples taken three days after the eruption was noted. Treatment was supportive, and symptoms resolved within a week.

"Zika virus infection must be suspected among individuals who have traveled to an area in which the infection has been reported and who develop an exanthema that may be accompanied by red or petechial patches on the palate, hyperemic eyes, fever, or arthralgias within two weeks of travel," Dr. Garg said. "The exanthema may be the most common feature of the presentation and thus represents a high-yield surveillance opportunity."

"The term 'morbilliform" is often used to generally describe the appearance of viral eruptions, though its use in the description of the exanthema associated with Zika infection may be inaccurate based on our observation of this case and our review of the literature," he continued. "A biopsy of the exanthema will not specify the infection. However, a dermatologist's examination may eliminate from consideration Zika infection in patients with other, more common eruptions."

Dr. Lola V. Stamm, of the University of North Carolina at Chapel Hill, who authored an accompanying viewpoint article, told Reuters Health by email, "A male colleague said to me, 'I'm not a pregnant woman, so I don't have to worry about Zika virus infection.' I'm concerned that many men (and some women) have a similarly shortsighted attitude."

"We all need to be concerned about the infection, which has the potential to place a considerable strain on our nation's health care system and poses ethical/moral/legal questions for pregnant women diagnosed with Zika virus infection and their partners," she concluded.

The authors reported no funding or disclosures.

SOURCE: http://bit.ly/1rP2eo3 and http://bit.ly/24UKfLi

JAMA Dermatol 2016.