{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T02:56:32Z","timestamp":1770432992152,"version":"3.49.0"},"reference-count":12,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,23]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Multisystem inflammatory syndrome in neonates (MIS-N) is a rare condition linked to perinatal exposure to SARS-CoV-2. We report a case of a term male neonate presenting at birth with severe respiratory failure and persistent pulmonary hypertension of the newborn. Initial evaluations, including chest X-ray and ECG, were unremarkable, but echocardiography showed elevated pulmonary pressures without structural abnormalities. Over the next few days, the infant developed diffuse skin peeling, acute kidney injury and hypertension, creating a perplexing clinical picture. Only after retrospective maternal history revealed a late-pregnancy febrile illness was SARS-CoV-2 testing performed: the mother was RT-PCR positive, and the neonate had markedly elevated SARS-CoV-2 IgG with negative RT-PCR, consistent with proposed diagnostic criteria for MIS-N. The infant responded well to methylprednisolone (2\u2009mg\/kg\/day) and intravenous immunoglobulin (2\u2009g\/kg). Serial echocardiography revealed diffuse endomyocardial and coronary intimal echogenicity suggestive of calcification, reproducible across time and imaging platforms, a feature not previously described in MIS-N. Persistent systemic hypertension was attributed to MIS-N after exclusion of other causes. The infant was discharged on aspirin (3\u2009mg\/kg\/day) and antihypertensives and remains well on follow-up. This case underscores the diagnostic challenges of MIS-N and highlights unusual sequelae such as myocardial calcification and neonatal hypertension.<\/jats:p>","DOI":"10.1136\/bcr-2025-270053","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T13:26:45Z","timestamp":1770384405000},"page":"e270053","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Endomyocardial calcification with pulmonary and systemic hypertension in a term neonate with multisystem inflammatory syndrome of newborn (MIS-N)"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1465-4203","authenticated-orcid":false,"given":"Swasthi Kabi","family":"Satpathy","sequence":"first","affiliation":[{"name":"Neonatology, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6292-110X","authenticated-orcid":false,"given":"Choudri Muzafar","family":"Paswal","sequence":"additional","affiliation":[{"name":"Neonatology, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neeraj","family":"Gupta","sequence":"additional","affiliation":[{"name":"Neonatology, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jai Prakash","family":"Soni","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Dr SN Medical College, Jodhpur, RJ, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8456-1133","authenticated-orcid":false,"given":"Sushil Kumar","family":"Choudhary","sequence":"additional","affiliation":[{"name":"Neonatology, AIIMS Jodhpur, Jodhpur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2026020605200569000_19.2.e270053.1","doi-asserted-by":"publisher","DOI":"10.1542\/neo.22-5-e1001"},{"key":"2026020605200569000_19.2.e270053.2","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1007\/s00431-022-04377-z","article-title":"Multisystem inflammatory syndrome in neonates (MIS-N) associated with SARS-CoV-2 infection: a case series","volume":"181","author":"More","year":"2022","journal-title":"Eur J Pediatr"},{"key":"2026020605200569000_19.2.e270053.3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4103\/jcn.jcn_1_22","article-title":"Clinical Profile, Laboratory Parameters, Management and Outcomes of Newborns with Multisystem Inflammatory Syndrome (MIS-N) due to Transplacental Transfer of SARS-CoV 2 Antibodies","volume":"11","author":"Balleda","year":"2022","journal-title":"J Clin Neonatol"},{"key":"2026020605200569000_19.2.e270053.4","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1159\/000524202","article-title":"Multisystemic inflammatory syndrome in neonates: a systematic review","volume":"119","author":"Shaiba","year":"2022","journal-title":"Neonatology"},{"key":"2026020605200569000_19.2.e270053.5","doi-asserted-by":"crossref","first-page":"101431","DOI":"10.1016\/j.siny.2023.101431","article-title":"Multisystem inflammatory disease in neonates (MIS-N) due to maternal COVID-19","volume":"28","author":"Ramaswamy","year":"2023","journal-title":"Seminars in Fetal and Neonatal Medicine"},{"key":"2026020605200569000_19.2.e270053.6","doi-asserted-by":"crossref","unstructured":"Charki S , V PS , P L , et al . Clinical spectrum and outcome of neonatal multi-system inflammatory syndrome (mis-n) - a prospective cohort study. Authorea [Preprint] 2022. doi:10.22541\/au.166979176.66104074\/v1","DOI":"10.22541\/au.166979176.66104074\/v1"},{"key":"2026020605200569000_19.2.e270053.7","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1055\/a-1733-4163","article-title":"COVID-19-Associated Multisystem Inflammatory Syndrome in a Neonate with Atypical Coronary Artery Involvement","volume":"29","author":"Costa","year":"2022","journal-title":"Am J Perinatol"},{"key":"2026020605200569000_19.2.e270053.8","doi-asserted-by":"crossref","first-page":"4083","DOI":"10.1007\/s00467-023-06061-2","article-title":"Hypertension after multisystem inflammatory syndrome in children (MIS-C)","volume":"38","author":"Lehman","year":"2023","journal-title":"Pediatr Nephrol"},{"key":"2026020605200569000_19.2.e270053.9","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s12098-022-04167-3","article-title":"Neonatal Multisystem Inflammatory Syndrome (MIS-N) Associated with Maternal SARS-CoV-2 Exposure","volume":"89","author":"Gupta","year":"2022","journal-title":"Indian J Pediatr"},{"key":"2026020605200569000_19.2.e270053.10","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1055\/s-0041-1726318","article-title":"Presumptive neonatal multisystem inflammatory syndrome associated with coronavirus disease 2019","volume":"38","author":"Divekar","year":"2021","journal-title":"Am J Perinatol"},{"key":"2026020605200569000_19.2.e270053.11","doi-asserted-by":"crossref","first-page":"101433","DOI":"10.1016\/j.siny.2023.101433","article-title":"Multisystem inflammatory syndrome in neonates (MIS-N) associated with perinatal SARS CoV-2 infection: Does it exist?","volume":"28","author":"Lakshminrusimha","year":"2023","journal-title":"Semin Fetal Neonatal Med"},{"key":"2026020605200569000_19.2.e270053.12","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1038\/s41390-022-02263-w","article-title":"Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management","volume":"93","author":"Molloy","year":"2023","journal-title":"Pediatr Res"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270053","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T13:26:47Z","timestamp":1770384407000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270053"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":12,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,6]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bcr-2025-270053"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270053","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}