COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C) simulating as acute appendicitis: A case report


  • Zorays Moazzam Medical College, Aga Khan University Hospital, Karachi, Pakistan
  • Areej Salim The Aga Khan University Hospital
  • Kiran Hilal Aga Khan University Hospital, Karachi, Pakistan
  • Muhammad Arshad Aga Khan University Hospital, Karachi, Pakistan



COVID-19, SARS-CoV-2, Multisystem Inflammatory Syndrome in Children (MIS-C), Kawasaki Disease


Background: As the COVID-19 pandemic continues to disrupt global affairs through a variety of manifestations, a severe presentation of some COVID-19 pediatric patients has emerged, presenting as multisystem inflammatory syndrome in children (MIS-C) that may mimic surgical conditions.

Case Presentation: We report the case of a 9-year-old boy who presented with acute, intermittent abdominal pain and fever. Further inquiry suggested a hyperinflammatory disorder affecting multiple organ systems. Upon COVID-19 PCR testing, the patient was reported as COVID-19 positive in the second test on the 2nd day of admission, after an initial negative test upon admission. We describe the course of this patient’s disease from presentation until discharge and discuss the emerging literature on this potentially fatal complication.

Conclusion: MIS-C should be a differential diagnosis in patients who may present with acute abdominal pain in the emergency room.


Download data is not yet available.


Metrics Loading ...

Author Biographies

Areej Salim, The Aga Khan University Hospital

Corresponding author

Kiran Hilal, Aga Khan University Hospital, Karachi, Pakistan

Department of Radiology,

Muhammad Arshad, Aga Khan University Hospital, Karachi, Pakistan

Professor of Pediatric Surgery


Palmeira P, Barbuto JAM, Silva CAA, Carneiro-Sampaio M. Why is SARS-CoV-2 infection milder among children? Clinics (Sao Paulo) [Internet]. 2020;75(18):e1947. Available from:

Dhochak N, Singhal T, Kabra SK, Lodha R. Pathophysiology of COVID-19: Why Children Fare Better than Adults? Indian J Pediatr [Internet]. 2020 Jul 14;87(7):537–46. Available from:

Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China. Am J Gastroenterol [Internet]. 2020 May;115(5):766–73. Available from:

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet [Internet]. 2020 May;395(10237):1607–8. Available from:

Tullie L, Ford K, Bisharat M, Watson T, Thakkar H, Mullassery D, et al. Gastrointestinal features in children with COVID-19: an observation of varied presentation in eight children. Lancet Child Adolesc Heal [Internet]. 2020;7(20):19–20. Available from:

Ramcharan T, Nolan O, Lai CY, Prabhu N, Krishnamurthy R, Richter AG, et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol [Internet]. 2020 Jun 12; Available from:

CDC. Health Department-Reported Cases of Multisystem Inflammatory Syndrome in Children ( MIS-C ) in the United States MIS-C Cases by Jurisdiction Race and Ethnicity of Reported MIS-C Cases. Available from: 2020;

WHO. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available from: 2020;(May):1–3.

Baker AL, Lu M, Minich LL, Atz AM, Klein GL, Korsin R, et al. Associated Symptoms in the Ten Days Before Diagnosis of Kawasaki Disease. J Pediatr [Internet]. 2009 Apr;154(4):592-595.e2. Available from:

Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute Heart Failure in Multisystem Inflammatory Syndrome in Children in the Context of Global SARS-CoV-2 Pandemic. Circulation [Internet]. 2020 Aug 4;142(5):429–36. Available from:

Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med [Internet]. 2020;1–13. Available from:

DeBiasi RL, Song X, Delaney M, Bell M, Smith K, Pershad J, et al. Severe Coronavirus Disease-2019 in Children and Young Adults in the Washington, DC, Metropolitan Region. J Pediatr [Internet]. 2020 Aug;223:199-203.e1. Available from:

Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children. Nat Rev Immunol [Internet]. 2020 Aug 16;20(8):453–4. Available from:

Tang A, Tong Z, Wang H, Dai Y, Li K, Liu J, et al. Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerg Infect Dis [Internet]. 2020 Jun;26(6):1337–9. Available from:



How to Cite

Moazzam Z, Salim A, Hilal K, Arshad M. COVID-19 Multisystem Inflammatory Syndrome in Children (MIS-C) simulating as acute appendicitis: A case report. J Pediatr Adolesc Surg [Internet]. 2020Aug.15 [cited 2022Jan.28];1(1):56-9. Available from:
Share |