text: Multisystem Inflammatory Syndrome in Children and Adolescents MIS C under the Setting of COVID 19 A Review of Clinical Presentation Workup and Management Earlier in its course SARS CoV 2 was primarily identified to cause an acute respiratory illness in adults the elderly and immunocompromised while children were known to be afflicted with milder symptoms However since mid April of 2020 latent effects of the virus have begun emerging in children and adolescents which is characterised by a multisystem hyperinflammatory state thus the term Multisystem Inflammatory Syndrome in Children MIS C was introduced by the WHO and CDC The syndrome manifests itself approximately 4 weeks after COVID 19 infection with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome Demographically MIS C peaks in children aged 5 to 14 years with clusters in Europe North and Latin America seen later followed by Asia Although the exact pathophysiology behind the syndrome is unknown recent studies have proposed a post infectious immune aetiology which explains the increased levels of immunoglobulins seen in affected patients Patient presentation includes but is not limited to persistent fever rash gastrointestinal symptoms and cardiac complications including myocarditis These patients also have raised inflammatory markers including C reactive protein ferritin and interleukin 6 In poorly controlled patients the syndrome can lead to multiorgan failure and death The mainstay of treatment includes the use of intravenous immunoglobulins steroids immune modulators and aspirin Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation Currently very little is known about the syndrome highlighting the need for awareness amongst healthcare workers and parents Moreover with increased cases of COVID 19 as a result of the second wave it is essential to keep MIS C in mind when attending patients with a past history of COVID 19 exposure or infection Additionally once these patients have been identified and treated strict follow up must be done in order carry out long term studies and to identify possible sequelae and complications 