PT  - JOURNAL ARTICLE
AU  - Shahnawaz M Amdani
AU  - Hannah S Kim
AU  - Anthony Orvedahl
AU  - Audrey Odom John
AU  - Ahmed Said
AU  - Kathleen Simpson
TI  - Successful treatment of fulminant neonatal enteroviral myocarditis in monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir
AID  - 10.1136/bcr-2017-224133
DP  - 2018 May 18
TA  - BMJ Case Reports
PG  - bcr-2017-224133
VI  - 2018
4099  - http://casereports.bmj.com/content/2018/bcr-2017-224133.short
4100  - http://casereports.bmj.com/content/2018/bcr-2017-224133.full
AB  - Neonatal cardiogenic shock most commonly occurs due to critical congenital heart disease, sepsis, metabolic disorder or arrhythmias. In particular, enterovirus infections are common in the neonatal period, and patients can present with fulminant myocarditis. Early recognition is imperative due to its high morbidity and mortality without prompt and aggressive treatment. We present the successful treatment of fulminant neonatal enteroviral myocarditis in a pair of monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir, an enteroviral capsid inhibitor. The twins took an almost exact parallel hospital course, including day of extracorporeal membrane oxygenation (ECMO) cannulation, day of ECMO decannulation, improvement of cardiac function, discharge and status at follow-up. While it was difficult to assess the relative contribution of each intervention, our case shows promise in the use of pocapavir for treatment of severe enteroviral infections. Remarkably, both twins demonstrated remarkable recovery within 2 weeks, underscoring that early aggressive cardiopulmonary support, and potentially pocapavir, contributed to their recovery.