Expanding spectrum of TORCH infections: A possible case of congenital Zika syndrome

Zika infection has been reported in many parts of India. Antenatal Zika virus infection can lead to congenital Zika syndrome (CZS), characterized by severe microcephaly, cortical malformations, subcortical calcifications, and ophthalmic abnormalities. The most common cause of microcephaly with intracranial calcification is toxoplasmosis, others (syphilis, HIV, parvovirus, and varicella), rubella, cytomegalovirus (CMV), and herpes simplex, particularly congenital CMV infection (cCMV). It is difficult to differentiate CZS from cCMV. The Fetal brain disruption sequence (FBDS), posterior fossa malformations, calcifications in subcortical, basal ganglia, and brainstem, retinal scar and retinal pigmentary mottling, and arthrogryposis are important pointers favoring CZS. We are presenting a case of severe congenital microcephaly, intracranial calcifications, FBDS, lissencephaly, and retinal scar, most probably CZS, as other etiologies were excluded from the study. Although the Zika polymerase chain reaction was negative, Zika serology could not be done.