Case Report: Multiorgan Involvement with Congenital Zika Syndrome

Abstract

We report the case of an infant born with congenital Zika syndrome (CZS). During the largest Zika virus (ZIKV) outbreak in Peru, the mother presented with fever and rash that were confirmed to be due to ZIKV by real-time PCR. The infant was born with severe microcephaly. Imaging revealed corpus callosum dysgenesis, lissencephaly, ventriculomegaly, and calcifications. Mild hypertrophic cardiomyopathy with diastolic dysfunction was reported in the echocardiogram. Valgus deviation of the lower extremities and a left clubfoot were diagnosed at birth. The hip ultrasound showed incipient signs of Graf type II dysplasia. The findings confirm that CZS is a multiorgan phenotype in which microcephaly is merely the tip of the iceberg. A multidisciplinary approach is needed for the evaluation of these children.

Figure 1.

Prominent microcephaly and retrognathia. This figure appears in color at www.ajtmh.org.

Figure 2.

Valgus deviation of lower extremities and left talipes equinovarus. This figure appears in color at www.ajtmh.org.

Figure 3.

Computed tomography of the head. (A) Axial view, calcifications in the left thalamus. (B) Axial view, right occipital and bilateral temporal calcifications.

Figure 4.

Magnetic resonance imaging of the head. (A) Sagittal view, absence of the corpus callosum and reduced brain volume at the expense of the frontal lobe. (B) Sagittal view, lissencephaly with hypoplasia of the temporal cortex. (C) Sagittal view, eyeball and optic nerve pathway. (D) Coronal view, smooth cortex with few grooves; absence of the corpus callosum without differentiation of the basal ganglia and the thalamus. (E) Coronal view, smooth cortex without cerebral grooves; evident dysmyelination. (F) Axial view, Probst bundles are seen by the occipital horns. (G) Axial view of temporal lobes with evident lissencephaly.