Rare case of respiratory syncytial virus induced myocarditis in a neonate: A case report

Table 1 Clinical course, key investigations, and management of the neonate with respiratory syncytial virus-associated myocarditis

Timeline	Clinical findings	Key investigations	Management
Day 1 (Admission)	Respiratory distress, O2 sat 86%, hypoactive, hoarse cry	ABG: Hypoxia/hypercapnia; CBC: Leukocytosis, anemia, thrombocytosis; CRP: 32.6 mg/L; CXR: Bilateral infiltrates	Mechanical ventilation, empirical antibiotics
Day 2–3	Persistent respiratory failure	RSV PCR positive, cultures pending	Continued supportive care
Day 3	Tachycardia, fever, cardiomegaly, increased infiltrates	ECG: ST/T changes; Troponin: 0.17 ng/mL; CK-MB: 60.5 U/L; Echo: ↓LVEF, LA/LV dilation, MR	Initiated furosemide, captopril, corticosteroids, L-carnitine, vitamin D
Day 4–12	Clinical improvement	Improved ABGs, FiO2 reduced	Extubated to CPAP, weaned off oxygen
Discharge	Hemodynamically stable, no respiratory distress	Normalized labs; Troponin: 0.02 ng/mL	Discharged with outpatient follow-up
1-week follow-up	Clinically stable, good systolic function	Echo: Moderate concentric LVH, no MR, trace TR	Continued outpatient care and serial follow-up

ABG: Arterial blood gas; CBC: Complete blood count; CK-MB: Creatine kinase-MB; CRP: C-reactive protein; CXR: Chest X-ray; ECG: Electrocardiogram; FiO₂: Fraction of inspired oxygen; LA: Left atrium; LV: Left ventricle; LVH: Left ventricular hypertrophy; CPAP: Continuous positive airway pressure; LVEF: Left ventricular ejection fraction; MR: Mitral regurgitation; PCR: Polymerase chain reaction; RSV: Respiratory syncytial virus; TR: Tricuspid regurgitation.