INTRODUCTION:

In December of 2019, a new strain of Corona virus emerged in Wuhan, China which resulted in the COVID-19 pandemic1. Among the children infected by the virus, most are asymptomatic and only few, especially infants and those with co-morbid conditions, have severe disease2. However, MIS-C, is a more severe form of disease occurring 4-5 weeks after the infection, and capable of causing multiorgan failure3. The hyperinflammatory state of MIS-C predisposes to a prothrombotic coagulopathy known as thrombo-inflammation making patients prone to thromboembolic complications including Pulmonary thromboembolism (PTE)4. Winant et al3 observed segmental pulmonary emboli in patients of MIS-C on thoracic imaging and recommended to have high suspicion of embolism in these patients. There are now emerging reports of Neonatal MIS-C (MIS-N), mainly presenting with cardiac manifestations, ground glass opacities in the lungs and elevated inflammatory markers 5,6,7,8,9. PTE is not common among the neonatal population and is a consequence of imbalance between procoagulant and anticoagulant systems10. Indwelling central lines, fluid instabilities, sepsis, liver dysfunction, congenital heart disease, occult malignancy, and systemic inflammation contribute to the risk profile for thromboembolism in critical neonates10,11.
Here we report a rare case of a neonate born to a mother with COVID 19 infection during pregnancy, who presented to us with respiratory distress, raised inflammatory markers and having cavitary and nodular lesions in the lung, which we suspect could have resulted from thromboembolic complication of MIS-N.