Unique presentations of the post COVID-19 infection, multisystem inflammatory syndrome in children.

Introduction: The epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing COVID-19, continuous to affect most of the world's population. In children, the respiratory and systemic involvement appears to have a much more benign course in comparison to adults, with almost no fatalities reported. However, we are encountering a post-infectious immune mediated condition, termed, multisystem inflammatory syndrome in children (MIS-C). In most cases the main features are prolonged fever and elevation of inflammatory markers, many of the patients present with abdominal pain and varying degree of myocardial involvement from mild reduction in cardiac output to the most alarming manifestation of cardiovascular shock. Results: We present two patients with unusual manifestations of MIS-C, related to post COVID-19 infection, an infant born to a mother who was severely ill at the very end of pregnancy, presenting with prolonged fever, rash, pericardial effusion, and evidence of coronary arteries wall thickening as a result of inflammation, and, a teenage girl with severe cardiac tamponade without the more common cardiac manifestations of myocardial involvement. Discussion: Post COVID-19 MIS-C can present in a wide variety of manifestations. The pathophysiologic mechanism underlying these inflammatory responses in infants are yet to be elucidated. Physicians should be aware of such presentations since rapid diagnosis and treatment are key for favorable outcome.