text: Multi system inflammatory syndrome in children during the coronavirus disease 2019 in Saudi Arabia Clinical perspective from a case series Most of the reports about severe acute respiratory syndrome coronavirus 2 SARS CoV 2 in children reported mild to moderate disease manifestations However recent reports explored a rare pediatric multisystem syndrome possibly associated with SARS CoV 2 infection termed multisystem inflammatory syndrome in children MIS C The study prospectively enrolled 5 patients with clinical and laboratory evidence of MIS C associated with SARS CoV 2 infection They were admitted to the pediatric intensive care unit PICU Their clinical presentation laboratory and outcome were described All patients shared similar clinical presentations such as persistent documented fever for more than 3 days respiratory symptoms gastrointestinal involvement and increased inflammatory markers CRP ESR and ferritin Three patients had concurrent positive coronavirus disease 2019 COVID 19 infection and the other 2 patients had contact with suspected COVID 19 positive patients They were all managed in the PICU and received intravenous immunoglobulin systemic steroid and hydroxychloroquine The hospital stays ranged between 3 and 21 days One patient died due to severe multiorgan failures and shock and the other 4 patients were discharged with good conditions Pediatric patients with SARS CoV 2 are at risk for MIS C MIS C has a spectrum of clinical and laboratory presentations and the clinicians need to have a high index of suspicion for the diagnosis and should initiate its early treatment to avoid unfavorable outcomes Long term follow up studies will be required to explore any sequelae of MIS C precisely the cardiovascular complications 