Discordant imaging findings in dizygotic twins with known exposure to maternal ZIKV infection during initial stages of pregnancy

Zika virus (ZIKV) is an arbovirus commonly transmitted to humans through the bite of an infected Aedes mosquito. Clinically, ZIKV is known to cause a wide range of symptoms, from febrile rash to severe neurological conditions, with congenital microcephaly being one of the most notable. Herein, we present a case of concurrent ZIKV infection in dizygotic twins, where only one twin developed microcephaly and severe encephalic malformations, while the other exhibited normal encephalic architecture. Our findings shed light on the complex interplay between ZIKV infection and the manifestation of neurological disorders while providing potential insights into the underlying pathological basis of ZIKV neuropathogenicity, particularly in relation to its association with the development of Dandy-Walker malformation. By examining the differential outcomes in twins exposed to the same viral infection, we contribute to the understanding of factors that may influence the development of severe neurological complications in ZIKV-infected individuals. Further research in this direction is crucial for developing targeted interventions and preventive strategies to mitigate the devastating effects of ZIKV infection, especially in pregnant women and their offspring.