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On January 2, 2016, a previously healthy 55-year-old male presented to a Massachusetts clinic with myalgia, headache, arthralgia, and subjective fever beginning 4 days earlier. He reported receiving many mosquito bites from December 19 to 26, 2016, while visiting the northwest coast of Costa Rica, a country where Zika virus prevalence had not yet been reported.
Examination revealed maculopapular rash on his face, trunk, and arms; conjunctivitis; and redness of the hard palate. Laboratory results showed a mild leucopenia as well as lymphopenia and bandemia, but platelet and erythrocyte levels were normal. Rapid streptococcal testing and malarial smears were negative. On January 7 (day 9 of illness), backache, conjunctivitis, and a faint rash …