Somewhat unrelated, but there's a Konami crossover racing game with Pyramid Head in it:

Or, we could have an actual twist where the entire game we are lead to believe that the protagonist killed a seven-year-old girl because there are flashbacks of the girl's parents beating him and calling him a monster because he "took their little girl away from them." But then at the end its revealed that our copy-paste straight white male hero was actually born a girl.

Hero's Girlfriend (after driving off transphobic thugs): Who were those people?
Hero: They looked like "people" to you?