Hypoxemic Respiratory Failure Secondary to Zika Virus Infection

An 80-year-old man experienced general weakness, myalgias, arthralgias, fever, chills, and diarrhea for one week. He had hypotension and tachycardia. He also had leukocytosis, thrombocytopenia, increased creatinine levels, elevated liver enzymes, elevated creatine phosphokinase (CPK) levels, and metabolic acidosis with hypoxemia, for which he was admitted to the Intensive Care Unit (ICU). His chest x-ray showed decreased lung volumes. Ceftriaxone and levofloxacin were empirically started to cover leptospirosis and community acquired pneumonia, respectively. The patient continued with clinical deterioration and the antibiotic therapy was changed to linezolid, cefepime, and doxycycline. He required endotracheal intubation and mechanical ventilation support due to progressive hypoxemic respiratory failure. A bronchoscopy showed no evidence of bacterial infectious process. The patient developed clinical improvement with successful extubation afterwards (4 days after initial intubation). He was later discharged home with physical therapies. A serum specimen was tested with real-time polymerase chain reaction (RT-PCR) technique, producing a positive result only for Zika virus. Confirmatory molecular diagnostic testing was performed at the Center for Disease Control (CDC).