BACKGROUND: Kawasaki-like syndrome occurring in children during the COVID-19 
pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) 
by the CDC and paediatric inflammatory multisystem syndrome temporally 
associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC.
CASE REPORT: We report the case of an 18-year-old male patient presenting with a 
72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and 
diarrhoea. Examination showed he also had shock and he was first thought to have 
oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was 
admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low 
ejection fraction and low cardiac index. High-sensitivity troponin serum levels 
were elevated. The patient received inotropic and vasopressor support. As he 
fulfilled several criteria for MIS-C/PIMS-TS, he was administered 
acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical 
response.
CONCLUSION: This case emphasizes how this severe presentation of COVID-19 can 
easily be misdiagnosed if the clinician is less aware of this syndrome in 
younger patients.
LEARNING POINTS: SARS-CoV-2 infection is a diagnostic challenge in some patients 
with atypical clinical presentations, who may have MIS-C/PIMS-TS.Physicians 
should be aware of this condition when evaluating teenagers and young adults 
with COVID-19.