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Sudden cardiac death in a young boy with multisystemic inflammatory syndrome in children (MISC)
  1. Gurudutta Avathi Venkatesha1,
  2. Nidhi Srinivas1,
  3. Saril Mohamedali2 and
  4. Supraja Chandrasekar3
  1. 1Paediatric Department, Rangadore Memorial Hospital, Bangalore, Karnataka, India
  2. 2Paediatric Emergency Department, AL Jalila Children's Specialty Hospital, Dubai, UAE
  3. 3Columbia Asia Referral Hospital Yeshwanthpur, Bangalore, Karnataka, India
  1. Correspondence to Dr Saril Mohamedali; smohamedali{at}


A previously healthy 12-year-old boy presented to the emergency department on the seventh day of illness with classical symptoms of postinflammatory multisystemic syndrome in children temporally associated with SARS-CoV-2 (fever, vomiting, loose stools and rashes all over the body) with COVID-19 seropositivity, high inflammatory markers and elevated cardiac enzymes with cardiogenic shock with multiple organ dysfunction syndrome. After having improved over the first 48 hours following intravenous immunoglobulin and pulsed steroids, this young boy developed sudden cardiac arrest and died. No reversible cause could be identified at the time of resuscitation. Despite an apparent clinical recovery in the myocardial function, it is likely that the myocardium remains arrhythmogenic due to cytokine-induced myocardial inflammation. There are several reports in the literature of fatality in multisystemic inflammatory syndrome in children (MISC) due to cardiovascular complication during the acute phase of the illness. To the best of our knowledge, this is the first report of sudden cardiac death in a child with MISC days after recovery from critical illness, suggesting that fatal outcome remains a potential risk during follow-up, even when there is no evidence of coronary aneurysm. Further studies are needed to identify clinical characteristics of such high-risk children presenting with MISC. We will need to follow these children closely to understand what implications they may have in the long term, and this helps in raising awareness among families of such children.

  • COVID-19
  • paediatrics
  • arrhythmias
  • heart failure

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  • Contributors Planning and design of study: GAV, NS, SM and SC. Reporting of work and acquisition of data: NS and SC. Analysis and/or interpretation of data: GAV and SM. Drafting the manuscript: NS and SC. Revising the manuscript critically for important intellectual content: GAV and SM. Approval of the version of the manuscript to be published: GAV, NS, SM and SC. Guarantor: SM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.