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uerto Rico has reported its first case of Zika-related microcephaly in a fetus that had a severely underdeveloped brain and brain lesions. The finding was disclosed in a press conference Friday in San Juan by Puerto Rican Health Secretary Ana Ríus Armendariz.

A statement from the department provided almost no details about the case, citing the need to protect the privacy of the family involved. But a tweet from Ríus Armendariz’s media briefing referred to it as a case of fetal loss — a miscarriage.

The fetus was tested in the laboratories of the Centers for Disease Control and Prevention, which confirmed the presence of the Zika virus. “This case of Zika virus disease in a pregnancy saddens and concerns us as it highlights the potential for additional cases and associated adverse pregnancy outcomes,” the Atlanta-based agency said in an emailed comment.

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Two previous cases of Zika-related microcephaly have been detected in the United States. In one, a baby born in Hawaii had a severe form of the condition; the newborn’s mother had lived in Brazil last spring during the early part of her pregnancy. In the other, a Finnish woman living in Washington, D.C., terminated a pregnancy after finding she was carrying a fetus with microcephaly. She had traveled in Central America during her first trimester.

For Puerto Rico, this case is a first but public health authorities fear it won’t be the last. To date, 128 pregnant women on the island have been diagnosed as having contracted Zika. And eight people — with a new case reported Friday — have developed Guillain-Barré syndrome, a progressive and temporary form of paralysis. One man has died.

There have been 925 confirmed Zika infections in Puerto Rico — likely a fraction of the real total — and the CDC has estimated as many as 1 in 5 of the territory’s 3.5 millions residents will have been infected by the end of the year.

The Aedes aegypti mosquitoes that transmit the Zika virus are plentiful on the island, which has had large outbreaks of dengue fever and chikungunya in the past. The belief is that places which have experienced outbreaks of these other mosquito-spread viruses are at high risk of Zika outbreaks as well.

For months authorities have said they want to do their utmost to protect pregnant women in Puerto Rico from contracting Zika. But they have faced intractable challenges when they have tried to deliver on that goal.

The economy of the territory is in shambles. Homes, even those in affluent neighborhoods, often do not have screens on windows and doors. A pilot project to install screens on the homes of pregnant women ran into a number of hitches, including the fact that some homes have openings under the eaves to allow for better air circulation.

As well, the constant heat is a powerful deterrent to taking the types of precautions advised to prevent mosquito bites. Sleeveless tops, shorts, skirts, and sandals are more common apparel for young women than shirts with long sleeves, long pants, and closed shoes.

STAT traveled to Puerto Rico in February to report on Zika there, meeting 22 year-old Alexandra Santiago at the time. Pregnant with her second child, Santiago admitted she had owned no long-sleeved tops prior to hearing about the Zika virus and the threat it poses in pregnancy.

Even after buying some, she didn’t always wear them. “Sometimes I do, sometimes I don’t,” Santiago said. “It’s Puerto Rico.”

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