Acute Zika infection with concurrent onset of Guillain-Barré Syndrome

A 47-year-old Tongan male returning to New Zealand after a 2-week holiday in Tonga presented with 3 days of progressive limb weakness, numbness, unsteady gait, and dyspnea. Two days before departing Tonga (6 days before neurologic symptoms), he developed leg swelling with erythematous and pustular lesions, which were treated with flucloxacillin. He had no medical history, was not taking regular medication, and had a 20 pack-year smoking history.

Examination findings included the following: afebrile, pulse 80 beats/min, blood pressure 150/90 mm Hg, respiration 20 breaths/min, and oxygen saturation 98% (air). Cardiovascular and abdominal examinations were unremarkable. Cranial nerves and eye movements were normal. Limbs were hypotonic with globally reduced power (4/5), areflexia, and absent plantar responses. Temperature and pain sensation were impaired in hands and feet. Proprioception and vibratory sensation were impaired in the feet. Romberg test was positive.