Fortunately, coronavirus disease 2019 (COVID-19) infection in pediatric populations exhibits a mild course of disease. However, a small number have recently been identified who develop a significant systemic inflammatory response, a new disease entity called multisystem inflammatory syndrome in children (MIS-C), especially after the peak of the wave in Al-Ahsa, Saudi Arabia, in early June to mid-July. In MIS-C children usually present a few days to a few weeks after recovery from COVID-19 with high grade fever, GI symptoms, Kawasaki-like picture or even toxic shock-like syndrome. Raising awareness about this disease entity is very fundamental to enable pediatricians and other health care providers to identify and manage these patients before it is too late. We describe 10 different cases of MIS-C with different risk factors and presentations.

The World Health Organization is still revising the epidemiology of multi-system inflammatory syndrome in children (MIS-C) and the preliminary case definition, although there is a dearth of robust evidence regarding the clinical presentations, severity, and outcomes. Researchers, epidemiologists, and clinicians are struggling to characterize and describe the disease phenomenon while taking care of the diseased persons at the forefronts. This report tackles the first case of a 13-year-old Saudi female with the MIS-C mimicking Kawasaki disease. Her main manifestations were fever, gastrointestinal symptoms, evidence of organ failure with an increase in inflammatory markers, and a history of coronavirus disease (COVID-19) infection. She had glucose-6-phosphate dehydrogenase (G6PD) deficiency and no significant previous history of any disease. She presented with signs of acute illness: high-grade fever (39.6°C) for five days accompanied by sore throat, malaise, reduced oral intake, abdominal pain, diarrhea, skin rash, bilateral non-suppurative conjunctivitis, and erythematous, cracked lips. Eventually, she died despite aggressive management based on the Centers for Disease Control and Prevention and the Saudi Ministry of Health guidelines for COVID-19 management. Based on this case, we suggest that pediatricians need to be aware of such atypical presentations and early referral to tertiary care is imperative for further early diagnosis and management. MIS-C is a rare yet severe and highly critical complication of COVID-19 infection in pediatrics, leading to serious and life-threatening illnesses. Knowledge about the wide spectrum of presenting signs and symptoms and disease severity, including early detection and treatment, is pivotal to prevent a tragic outcome.

Kikuchi-Fujimoto Disease (KFD) is a rare self-limiting condition of unknown etiology. It is characterized by fever, and lymphadenopathy most commonly involving posterior cervical lymph nodes. Although it is of uncertain etiology, it is associated with viral infections and autoimmune diseases. Distinction from lymphadenopathy-associated alternate disorders is crucial to avoid unneeded diagnostic procedures and treatment. KFD is diagnosed based on histopathologic examination of the excised lymph node. The management is supportive with favorable outcomes within a few weeks or months. In this case, we describe a 13-year-old boy who complained of painful cervical lymphadenopathy and fever for more than three weeks following COVID-19. Diagnostic workup has been established and KFD diagnosis made based on the histopathologic features of the involved lymph node. The patient showed complete recovery with no recurrence during follow-up. So, this case highlights the possible association between COVID-19 and KFD during this pandemic and keeping it in the differential diagnosis.

Coronavirus disease 2019 (COVID-19) is an emergent disease that has spread rapidly to infect more than 210 countries across the world. With the increasing number of infected pregnant women, many physicians hypothesized the perinatal transmission as a potential route of transmission. Some cases of perinatal transmission have been described, but it is unclear if these occurred via the transplacental or the transcervical routes or through environmental exposure. In this report, we described a case of a female infant who was delivered by caesarean section at 34 weeks' gestation to an infected mother. The neonate was transferred into the Neonatal Intensive Care Unit (NICU) Level 3, with the precaution of airborne and contact isolation. All required investigations were performed, including blood gases, nasopharyngeal swab, chest x-ray, and echocardiogram. On the fifth day of delivery, her investigations demonstrated a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Despite applying all recommended guidelines and following the treatment protocol, she developed severe respiratory symptoms with persistent pulmonary hypertension, which progressed significantly to her death.

In this study, we aimed to examine the association between sources of admission (either intra-hospital transfers or ED admissions) in pediatric intensive care units (PICUs) and the discharge rate, mortality rate, and referral over a period of three years. We also sought to identify the independent predictors of discharge and mortality rate in the study population. Patients and methods This was a retrospective cohort study involving the analysis of 2,547 patients' data collected from the Pediatric Intensive Care Registry of a secondary care community hospital. We included patients admitted to the PICU from January 1, 2016, till December 31, 2018, who were aged 0-14 years with a specific diagnosis, recorded source of admission, and clear outcome. Data were collected, coded, and analyzed using the SPSS Statistics software (IBM, Armonk, NY) and STATA software (StataCorp, College Station, TX). Results Of the included patients, 1,356 (53.2%) were males, and 1,191 (46.8%) were females. Infants were associated with an increased risk of a long stay in the hospital [relative risk ratio (RRR)=5.34, 95% CI: (1.28, 22.27)] and mortality [RRR=3.56, 95% CI: (1.41, 8.95)] compared to older children. Similarly, neonates were associated with a higher risk of mortality [RRR=2.83, 95% CI: (1.05, 7.65)]. Patients who were admitted through ED were associated with a lower risk of a long-stay [RRR=0.56, 95% CI: (10.36, 0.87)] and mortality [RRR=0.68, 95% CI: (0.49, 0.95)] compared to intra-hospital transfers. Concerning the admission date, all time periods were associated with a lower risk of mortality compared to the period of October-December. Conclusion Our findings showed that the age of patients, source of admission, and date of admission might be used as independent predictors for determining the outcome of admissions, including discharge and mortality rates. Further studies are required to confirm these findings.