The current outbreak of Zika virus (ZIKV) infection has been associated with an apparent increased risk of congenital microcephaly. We describe a case of a pregnant woman and her fetus infected with ZIKV during the 11th gestational week. The fetal head circumference decreased from the 47th percentile to the 24th percentile between 16 and 20 weeks of gestation. ZIKV RNA was identified in maternal serum at 16 and 21 weeks of gestation. At 19 and 20 weeks of gestation, substantial brain abnormalities were detected on ultrasonography and magnetic resonance imaging (MRI) without the presence of microcephaly or intracranial calcifications. On postmortem analysis of the fetal brain, diffuse cerebral cortical thinning, high ZIKV RNA loads, and viral particles were detected, and ZIKV was subsequently isolated.

(N Engl J Med. 2016;374:2142–2151) Zika virus (ZIKV), a mosquito-borne flavivirus, is associated with intrauterine or perinatal transmission and increased risk of having a newborn with microcephaly. In the present study, the authors present findings on a case of congenital ZIKV infection in a pregnancy that was terminated at 21 weeks gestation.

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