The varied spectrum of presentation of the severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2) is intriguing. Multisystem inflammatory syndrome in 
children (MIS-C) is a well described and documented condition that is associated 
with the active or recent COVID-19 infection. A similar presentation in adults 
is termed as Multisystem inflammatory syndrome in Adults (MIS-A). With only very 
limited cases reported from the west, MIS-A is considered a rare and serious 
complication of COVID-19. However, it is not as uncommon as we think. Many cases 
go undiagnosed for lack of COVID -19 like symptoms and unawareness among 
treating clinicians about this newer clinical entity. Further, antibody testing 
and inflammatory markers are not easily available in many of the Indian 
hospitals especially in rural India where the second wave had been intense, 
thereby making it difficult for the diagnosis of MIS-A. Also, there is no clear 
treatment guideline for MIS-A unlike MIS-C where the treatment protocol is well 
laid out. Awareness about MIS-A among treating clinicians can thus help in 
further evaluation and increased identification of the syndrome at the early 
stages thereby helping in the early institution of treatment. Our tertiary COVID 
care hospital in South India which has handled about 5200 cases of COVID-19 is 
been able to identify 04 cases of MIS-A proving that this clinical entity is not 
as rare as it is thought but lacks reporting and prompt identification. Here we 
describe 04 cases of MIS-A and strive to bring in the various aspects of it, 
including the clinical presentation, laboratory markers, diagnostic criteria and 
treatment considerations in this post second wave of the COVID-19 pandemic in 
India.