COVID-19: Pediatric Multisystem Inflammatory Syndrome

This case was written by Drs. James Leung and Meagan Doyle. Dr. James Leung is an Assistant Professor and Attending Physician in the Division of Pediatric Emergency Medicine, at McMaster University in Hamilton, Ontario, Canada.  He is the Director of Simulation for Pediatric Emergency Medicine at McMaster University. He is a design thinker, passionate about understanding the translational outcomes of simulation on improving the care of children. Dr Doyle is a Clinical Assistant Professor at McMaster University and Attending Physician at McMaster Children’s Hospital.


Taking care of the sickest children in the emergency department needs more than individual excellence. It requires a robust, coordinated effort by the bedside team and the entire hospital-wide system.

This case was designed during the 2020 COVID-19 pandemic to assess and improve team safety and preparedness to effectively manage a critically ill pediatric patient with cardiogenic shock from multi-system inflammatory syndrome, possibly linked to


Elliot, a seven-year old boy, is brought to the emergency department after six days of fever and lethargy. He has a rash, diarrhea and decreased urine output. Both his parents are healthcare workers with possible COVID-19 exposures.

Case Summary

A 7-year old boy has suspected COVID-19 with multisystem inflammatory syndrome. He presents moderately unwell, but gets progressively sicker in the resuscitation bay, going into cardiogenic shock. This must be treated with careful fluid resuscitation, and eventually vasopressors. A novel option for push-dose vasopressor is explored. Cardiology and PICU should be involved early in the case.

Downlad the case here: COVID-19 Pediatric MIS

Xray: Case courtesy of Dr Jeremy Jones,, rID: 41667
Photo: Facial features of Kawasaki Disease (Wikipedia)
ECG: ECGpedia

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