A previously healthy 12-year-old boy presented to the emergency department on the seventh day of illness with classical symptoms of postinflammatory multisystemic syndrome in children temporally associated with SARS-CoV-2 (fever, vomiting, loose stools and rashes all over the body) with COVID-19 seropositivity, high inflammatory markers and elevated cardiac enzymes with cardiogenic shock with multiple organ dysfunction syndrome. After having improved over the first 48 hours following intravenous immunoglobulin and pulsed steroids, this young boy developed sudden cardiac arrest and died. No reversible cause could be identified at the time of resuscitation. Despite an apparent clinical recovery in the myocardial function, it is likely that the myocardium remains arrhythmogenic due to cytokine-induced myocardial inflammation. There are several reports in the literature of fatality in multisystemic inflammatory syndrome in children (MISC) due to cardiovascular complication during the acute phase of the illness. To the best of our knowledge, this is the first report of sudden cardiac death in a child with MISC days after recovery from critical illness, suggesting that fatal outcome remains a potential risk during follow-up, even when there is no evidence of coronary aneurysm. Further studies are needed to identify clinical characteristics of such high-risk children presenting with MISC. We will need to follow these children closely to understand what implications they may have in the long term, and this helps in raising awareness among families of such children.

A previously well, 7-month-old baby boy presented with a 6 h history of lethargy. On examination, he was drowsy and responsive only to painful stimuli (Glasgow Coma Score 9/15). Vital parameters were normal. Detailed systemic examination was normal. The patient was commenced on antibiotics in view of non-specific findings of lethargy in an infant. A few hours later, the mother reported an episode of uprolling of eyes with jerking of limbs. An array of investigations to rule out meningoencephalitis, toxic ingestion, sepsis, metabolic disease and intracranial pathology were within normal limits. The following day the patient passed stools with a few fresh blood stains. He was noted to have a 2×3 cm mass in the left upper quadrant of the abdomen. Abdominal x ray and ultrasound were undertaken to rule out intussusception, and were reported as normal. However, in view of the high index of suspicion for intussusception, the patient was transferred to a tertiary hospital for further evaluation and management. He continued to be lethargic, and a repeat ultrasound at the tertiary hospital revealed intussusception. The patient underwent laparoscopic hemicolectomy as air reduction was unsuccessful. The postoperative course was uneventful and the infant made a complete recovery.