Glomerular capillary tuft collapse and podocytopathic changes in a newborn with congenital Zika virus syndrome

Introduction: In early 2015, several patients presenting with dengue-like symptoms were described in Brazil′s northeast region. Reverse transcription polymerase chain reaction (RT-PCR) results from patients′ sera revealed the Zika virus (ZIKV) infection. In parallel, an unusually high incidence of microcephaly in newborns was observed in the same region. Zika virus infection can induce microcephaly and congenital abnormalities. Case Report: A male newborn (9 months of gestation, cesarean delivery) died within 20 hours. The mother had a confirmed viral infection in the third month of pregnancy. This report describes a case of ZIKV intrauterine infection associated with histologic alterations in the newborn kidney tissue. Immunohistochemistry, RNA extraction, and real-time RT-PCR were performed for the confirmation of ZIKV infection in tissues. Kidney samples were stained using conventional hematoxylin-eosin (H&E), methenamine silver, and periodic acid-Schiff with diastase digestion techniques. Analysis of brain tissue revealed severely affected gray and white matter sites of neuronophagy, gliosis, and calcium microdeposits. Immunohistochemistry (4G2 and specific anti-ZIKV monoclonal antibodies) showed diffusely distributed immunopositivity in glial cells. Aspects compatible with a focal segmental glomerular capillary tuft collapse associated with podocytopathic features with pseudo-crescent formation were observed in the kidney tissue. Conclusion: This case suggests the ability of congenitally acquired ZIKV to produce alterations in renal cells and describes histological details of kidney involvement.