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Facial Puffiness in a Returning Traveler From Puerto Rico: Chikungunya, Dengue Fever, or Zika Virus?

  1. Natalie C. Klein1,2
  1. 1Infectious Disease Division, Winthrop University Hospital, Mineola
  2. 2State University of New York, School of Medicine, Stony Brook, New York
  1. Correspondence: B. A. Cunha, Infectious Disease Division, Winthrop University Hospital, 222 Station Plaza N (Ste 432) Mineola, NY 11501 (bacunha{at}

To the Editor—Clinical manifestations of Zika, dengue, and chikungunya infections have many features in common [17]. We report a case of Zika virus infection in a traveler returning from Puerto Rico, with fever, rash, myalgias/arthralgias initially thought to be dengue fever because of her facial puffiness and palatal petechiae.

A 41-year-old woman was admitted with fever, rash, headache, and myalgias/arthralgias for 4 days after returning to New York from Puerto Rico, where she reported multiple mosquito bites. One day before admission, a generalized nonpruritic maculopapular rash had developed. The patient reported fevers at home but she was afebrile on admission. Physical examination was remarkable for …


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