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Go there (adapt to wherever you installed Steam):
C:\Program Files (x86)\Steam\steamapps\common\The Binding of Isaac Rebirth\resources
Delete everything except "packed".
So what happened was I originally beat Mom, It Lives, and Isaac with ??? all for the first time on the same run (I got Brimstone and Tammy's Head lol). I got the D6 achievement on Steam but didn't get the "secret" in-game. As it turns out if you beat It Lives and Isaac for the first time on the same run, the game only registers It Lives on the little paper progression tracker (not sure if that's intentional or a bug), but the game legit didn't register that I beat Isaac, and so I had to bloody do it again, which I did and now I do have the D6 on Isaac.