Article Text

Download PDFPDF
Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS) — A mimic of intra-abdominal malignancy
  1. Omar Nasher1,
  2. Amand Friend2,
  3. Bhanumathi Lakshminarayanan1,
  4. Kerry Turner3,
  5. Mark Wood4,
  6. Antigoni Deri5 and
  7. Danielle Ingham2
  1. 1Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  3. 3Cellular Pathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Paediatric Rheumatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5Paediatric Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  1. Correspondence to Danielle Ingham; danielle.ingham{at}


We report the case of a school-aged boy who presented with clinical features suggesting acute appendicitis. However, further imaging which included CT, demonstrated an inflammatory mass involving the transverse colon raising the suspicion of lymphoma. He then developed intestinal obstruction, and in view of the rapid progression of the disease, he was thought to have non-Hodgkin’s lymphoma. He underwent an open excisional biopsy, which revealed a necroinflammatory process and no suggestion of lymphoma or an alternative malignancy or specific diagnosis. His steroid treatment was stopped, and he made a good recovery postoperatively. Positive COVID-19 antibodies, positive response to steroids, results and clinical features were consistent with paediatric inflammatory multisystem syndrome (PIMS-TS), with extensive investigation not offering an alternative diagnosis.

While PIMS-TS is a relatively new entity, we believe that this case highlights the importance of it being considered a differential diagnosis of a child presenting with an inflammatory mass.

  • COVID-19
  • Paediatric oncology
  • Pathology
  • Paediatric Surgery
  • Gastroenterology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ON, AF, BL, KT, MW, AD, DI have contributed in the following: conception—revising the article critically for important intellectual content; final approval of the version published; agreement to be accountable for the article.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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