text: Pediatric Inflammatory Multisystem Syndrome Temporally Related With SARS CoV 2 Immunological Similarities With Acute Rheumatic Fever and Toxic Shock Syndrome Several studies demonstrated that COVID 19 in children is a relatively mild disease However recently a more serious condition characterized by systemic inflammation with clinical or microbiological evidence of exposure to SARS CoV 2 has been described This syndrome is now known as either Pediatric Inflammatory Multisystem Syndrome temporally related with COVID 19 PIMS TS 1 or Multisystem Inflammatory Syndrome in Children MIS C 2 and is currently considered a rare post COVID 19 complication which in a minority of cases can lead to death The signs and symptoms of PIMS TS are largely overlapping with the for Kawasaki disease KD and toxic shock syndrome TSS and are characterized by fever systemic inflammation abdominal pain and cardiac involvement In this study we describe clinical and immunological characteristics shared by PIMS TS acute rheumatic fever and TSS in order to provide hypotheses to direct future clinical and basic research studies 