Zika Virus–Associated Septic Shock in an Older Thai Patient: A Case Report and Literature Review

Abstract

Zika virus (ZIKV) infection is generally a mild and self-limiting illness that most commonly presents with fever, rash, and arthralgia. Severe manifestations leading to significant morbidity or mortality are rare and generally occur in older adults with underlying comorbidities. Herein, we report the case of an 87-year-old man who presented with fever, confusion, hypotension, and dyspnea consistent with acute respiratory failure and septic shock. Chest radiography revealed pulmonary edema, while echocardiography revealed mildly impaired left ventricular systolic function. Increased cardiac biomarkers and a negative coronary angiogram suggested myocarditis. Molecular testing of the serum, cerebrospinal fluid, and endomyocardial tissue confirmed ZIKV infection. The patient was managed with intensive supportive care, including fluid resuscitation, vasopressors, and symptomatic treatment. His condition gradually improved following the resolution of septic shock and cardiac abnormalities. This case highlights the potential for severe ZIKV infection in older adults with comorbidities, underscoring the importance of considering ZIKV in the differential diagnosis of patients with fever, rashes, and septic shock in endemic regions. Early recognition and supportive management play critical roles in improving outcomes in severe ZIKV cases.