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As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from different parts of India during second wave of infection describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. We describe clinical features and management in children with multisystem inflammatory syndrome children (MIS-C) from the Delhi metropolitan area, which had a high incidence of coronavirus disease 2019 (COVID-19). We report a similar case presenting with persisting fever, rashes, bulbar conjunctivitis, abdominal pain, decreased urine output and shock. Initial reports suggestive of high inflammatory markers, neutrophilic leukocytosis, high D-dimer and found to have COVID-19 IgG antibodies positive in high titre. Managed successfully in PICU with bolos fluids, intravenous antibiotics, steroids and anticoagulation.

BACKGROUND: Chilaiditi sign is an uncommon illness characterized by radiological evidence of colonic interposition between the liver and the diaphragm or abdominal wall. This is often confused with the pneumoperitoneum; hence it is important to differentiate the two entities as former is managed conservatively whereas latter requires surgical intervention. This case reports aims to highlight the dilemma faced by the physicians in the emergency room between the two entities.