Non-COVID infections causing MIS-C in COVID recovered children: An association or co-illness - A case series

With the emergence of severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) pandemic, multi-system inflammatory syndrome (MIS-C) is being reported all across the world. Why some children develop it whereas others do not and the various implicating agents for the same are not clear. It has been seen that various infections are associated with immune mediated diseases. Whether new infections, in COVID recovered children, can lead to the cascade of MIS-C is still a matter of debate. We report a case series of four cases of MIS-C all subsequent after bacterial or viral infection in COVID recovered children. All children had a documented evidence of past SARS-CoV-2 infection and present bacterial or viral infection. They were given the required management as per the concerned infection but none improved after standard therapy. All children showed drastic improvement after initiation of specific therapy for MIS-C. It is important to understand increased risk of MIS-C with new onset viral and bacterial infections in COVID recovered children.