Description of atypical pattern in twins with presumed congenital Zika and without microcephaly - Case Report

Zika virus (ZIKV) infection was a public health emergency of Brazilian national interest until May 2017, due to the sudden increase in newborns with microcephaly and other neurological alterations during the epidemic started in Brazil in November 2015. The manifestations of Intrauterine infections by ZIKV are more severe when they occur in the first and second trimesters of gestation, especially in the first trimester. In this situation, early diagnosis of visual problems is essential for patients to progress in the neurological and motor fields, and there are complications such as refractive errors (myopia, astigmatism and hyperopia), strabismus and hypoactomy. The absence of microcephaly in infants exposed to the zika virus is not indicative of changes in ophthalmology, and it is essential that the ophthalmologist perform the investigations that are relevant to the clinical case. Any and all eye lesions and their consequences are serious. The earlier the diagnosis, the sooner the child can undergo an intervention to enable vision. Objective: To analyze atypical pattern in twins with presumed congenital zika and without microcephaly. Method: This is a case report, developed in the city of Serra Talhada, in the state of Pernambuco, Northeast Brazil. Report: Case of twins whose mother was exposed to zika virus in the second trimester of gestation (eleventh week). The children were born prematurely and without microcephaly. One of the twins had hydrocephalus requiring surgery. The same child was taken for ophthalmologic examination because of convergent strabismus; and hypocortical optic nerve and chorioretinal scar were found in the macular region in both eyes similar to the lesions described by zika virus. A similar scenario, but with less visual impairment was identified in the second twin. Skull tomography demonstrated bilateral calcification foci in the cerebral hemispheres. Conclusion: There was presence of convergent deviation and nystagmus to lateroversions. In the funduscopy, the optic nerve was pale and with cicatricial chorioretinal lesion with well delimited edges in the macular area of both eyes.