Neonatal Enterovirus Myocarditis With Severe Dystrophic Calcification: Novel Treatment With Pocapavir

Abstract

Dystrophic myocardial calcification occurs in the setting of myocardial injury and normal serum calcium. We present a case of a neonate with prominent dystrophic calcification and severe left ventricular systolic dysfunction in the setting of enterovirus myocarditis. These findings are superbly illustrated by multiple imaging modalities. The patient was treated with the novel antiviral, pocapavir, in addition to a standard heart failure regimen. The dystrophic calcification persisted but the left ventricle remodeled significantly. To our knowledge, this is the first reported use of pocapavir for this indication. The literature regarding enterovirus myocarditis and pocapavir is briefly reviewed.

Giant congenital right atrial epithelioid‐capillary hemangioma with prolonged QT interval: Case report and practical surgical treatment strategy for primary cardiac tumors in children based on 25‐year review of 299 cases

“…Calcification is not a feature of cardiac hemangioma . Calcification in our case may be explained by rapid intrauterine growth of the tumor and consequent ischemic necrosis and dystrophic calcification in areas of necrosis . Sebastian et al reported rapid intrauterine growth and doubling of the size of a CH after 29‐week gestation in a preterm neonate with right atrial hemangioma.…”

Enteroviral Infections in the First Three Months of Life

“…The second study reports the use of Pocapavir and intravenous immunoglobulins (IVIG) in a late preterm female presenting at 14 days of life with EVs myocarditis and hepatitis. The neonate had improved liver function after antiviral treatment, despite persistence of a dilated cardiomyopathy [92]. Finally, Pocapavir use was reported in two monochorionic diamniotic twins who both presented with EVs myocarditis and cardiogenic shock on Day 12 of life.…”

Management of neonatal central nervous system viral infections: Knowledge gaps and research priorities

“…It has been used with favourable outcomes in a case of enteroviral sepsis, with significantly improved myocardial output and coagulopathy, although these were improving prior to commencement of drug 89 . Two isolated case reports of neonates with fulminant neonatal myocarditis have demonstrated viral clearance and recovery within 2 weeks without adverse effects—currently this investigational drug has been only available in these limited number of cases as emergency treatment 73,74 . Emergency investigational new drug approval from the Food and Drug Administration, parental consent, and placental enteroviral typing and pocapavir susceptibility testing were required prior to the use of the first case 89 .…”

“…A number of drug candidates target the capsid, including pleconaril, pocapavir and suramin (Table 2). Randomised placebo-controlled trial 71 In vitro 72 Case reports 73,74 Currently being trialled in phase 1 75,76 In vitro 69 In vitro In vitro 77 Mouse models 78 In vitro 79 In vitro 80 Improved Currently being evaluated from clinical trial 63 Phase II studies 82,83 Phase II/III studies 84,85 In vitro 86 In vitro 87 Awaited Reduce viral shedding in HSV2seropositive individuals with annually recurrent genital herpes, over 28 days compared to oral valaciclovir. 82 93 Furthermore, the inactivated, vero cell-based EV71 Sinovac vaccine showed non-inferior immunogenicity in infants 3-5 years to those aged 6-35 months.…”