Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection associated with significant morbidity and can be fatal if left unrecognized. A retrospective multicentric study was carried out at five tertiary care centers in South India, to evaluate the clinical profile of children admitted with MIS-C associated with SARS-CoV-2 infection. Cases of MIS-C diagnosed during October 2020 to December 2021 were included. Diagnosis of MIS-C was based on World Health Organization (WHO) criteria. All children underwent echocardiography at admission, discharge, and 4–6 weeks of follow-up. Children with MIS-C were treated with intravenous immunoglobulin (IVIG) and/or steroids. We compared younger children (<5 years of age) with older ones to determine if age at presentation could predict severity in children with MIS-C. A total of 81 children were diagnosed to have MIS-C during the study period. The mean age of presentation was 6.8 years. Around 29.6% of the children had a shock at admission and 54.3% had myocardial dysfunction. The average duration of a pediatric intensive care unit (PICU) stay was 6.6 days. Anti-SARS-CoV-2 antibodies were found to be positive in 75.3% of patients. Children with high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) had more severe presentations. All children responded promptly to IVIG and steroids and the mortality was 0%. No difference was noted in terms of outcome between younger (<5 years) and older children. A significant proportion of children with MIS-C present with shock and myocardial dysfunction. Anti-SARS-CoV-2 antibodies were positive in 75% of children whose primary infection went unnoticed. We hereby report one of the largest cohorts of MIS-C patients from the Indian subcontinent.

Background: India is endemic to both typhoid and dengue, which also mimic in their clinical presentations. This poses a diagnostic dilemma especially for pediatric patients. Literature on such coinfections is limited. Methodology: We retrospectively analyzed six years data (2017–2022). All pediatric culture proven typhoid cases with concurrent dengue infection were included in the study. Patient clinical and demographic profiles were extracted from the hospital information system. Results: We report four such cases of coinfection. Along with the expected reduced platelet counts, most of the patients had associated deranged TLC, liver enzymes, hypoalbuminemia and gallbladder changes. Conclusion: Our study contributes to the body of literature on dengue–typhoid coinfection in pediatric patients and the pitfall in accepting a single pathogen etiology. Awareness needs to be raised among healthcare workers on the potential dengue–typhoid coinfection, especially in endemic countries.

Background: COVID-19 is a highly infectious disease with a wide range of symptoms, from asymptomatic to acute respiratory distress syndrome that may even lead to death. Tuberculosis also is one of the deadliest respiratory infections. There is still a lack of literature about coinfection of these diseases in both adults and children. Materials and methods: This retrospective study was performed in a tertiary care hospital in Mumbai, in which children with TB and those without a TB diagnosis were enrolled. All patients were tested for COVID-19 infection. Variables significantly associated with COVID-19 positivity, in children with TB were assessed and analyzed. Treatment protocols for COVID-19 were compared in children with TB and those without. Results: No variable was significantly associated with COVID-19 positivity in children with TB. The mean duration of hospital stay for COVID-19 was not significantly different between the TB and non-TB groups. COVID-19 treatment did not differ in children with TB compared to those without. In both groups, children who succumbed to COVID-19 were the ones who required invasive ventilation along with steroids and had significant lesions on their chest radiology. Symptomatic treatment was all that was needed for the vast majority of the milder cases. Conclusion: The management of COVID-19 is unrelated to the status of TB infection. We must fight new pandemics while ensuring that those in need of attention from ongoing illnesses like TB are provided with uninterrupted health care. We should not forget to suspect and manage TB appropriately (in the case of coinfection), as it is still one of the leading infectious causes of death worldwide.

Introduction: Kawasaki disease (KD) is a medium-vessel vasculitis with a predilection for coronary arteries and has been recognized to be the most common cause of acquired heart disease in children (Hedrich et al., 2018; Newburger et al., 2016; Saguil et al., 2015; Singh et al., 2018; Sundel, 2015). Hedrich et al. (2018) outline how coronary artery aneurysms are a typical manifestation of KD that develops after several weeks of disease. Case presentation: This case report describes the clinical course and outcomes of a patient, a 5-year-old Hispanic female with KD who displayed early development of coronary microaneurysms as opposed to the typical late sequelae development. Discussion and conclusion: This unique presentation of KD highlights some crucial questions that should be addressed, including whether coronary artery aneurysms should be reconsidered as only a late sequela of untreated disease. Can coronary artery aneurysms be an early manifestation of KD?

Introduction: A brain abscess is an intraparenchymal collection of pus in the brain. Cerebral palsy (CP) is a static encephalopathy due to injury to the developing brain. CP is a group of disorders due to multiple etiologies. We are reporting a rare cause of brain abscess presenting as CP. Case description: A 12-month-old boy presented with a developmental delay with perinatal depression. He had attained only partial head control. On examination, head size was 42.5 cm between –2SD and –3SD, and tone was increased in both spasticity and dystonia with exaggerated deep tendon reflexes. On investigations, complete blood count, liver function test, and renal function test were normal. Magnetic resonance imaging (MRI) of the brain showed two ring-enhancing lesions in the left frontal and right temporoparietal lobe. The cerebrospinal fluid (CSF) showed two lymphocytes, protein of 32 mg/dL, and glucose of 60.1 mg/dL. Due to nonreduction in size of the abscess on repeat MRI of the brain after 4 weeks of intravenous antibiotics, the child underwent burr hole aspiration of abscess in the left frontal lobe. The intravenous antibiotics continued for another 4 weeks. On follow-up, computed tomography (CT) of the brain showed a reduction in the size of brain abscesses with calcification. The child attained a social smile, reached for objects, and his tone was improved. Conclusion: For any child presenting with developmental delay with perinatal history of hypoxic–ischemic encephalopathy (HIE), neuroimaging should be done as it gives important clues for etiology and helps in specific management and prognosis.

Introduction: Central Nervous System infections are the most common cause of mortality and morbidity in developing countries. We are reporting a rare case of neuroinfection following drowning. Case description: Fourteen-year-old boy with a history of near drowning was initially treated for respiratory distress requiring mechanical ventilation and a right femur fracture. He was all right for 15 days at home later he developed a fever and weakness in his left lower and upper limbs. MRI of the brain showed a mass lesion with vasogenic edema requiring decompression craniotomy. Brain biopsy during decompressive craniectomy showed granulomatous inflammation composed of sheets of histiocytes, lymphocytes, and many foreign body giant cells. PAS and GMS stains highlight fungal hyphae/pseudohyphae. Conclusion: Fungal meningoencephalitis should be considered in case of neuro infection following near drowning in addition to bacterial infections and should be treated urgently.

Globicatella sanguinis (G. sanguinis) is a gram-positive cocci resembling viridans streptococci. Hospital-acquired infection (HAI) with G. sanguinis has been very rarely reported. Here, we are reporting a rare case of HAI by G. sanguinis in a neonate who presented with prolonged hypoglycemia.

Aim and objective: To highlight the importance of looking for multisystem inflammatory syndrome in children (MIS-C) as an etiology of pancreatitis in children. Background: MIS-C is a newly recognized, potentially serious illness in children related to COVID-19. MIS-C has varied symptoms that affect several organ systems in body. Many children have symptoms resembling Kawasaki disease. Some children have signs of excessive blood clotting, gastrointestinal symptoms, kidney injury, or neurological symptoms. To date, very few cases have been reported with acute pancreatitis with SARS CoV-2 infection in children and only two cases with subsequent inflammatory syndrome. Case description: A 12-year old male child with severe necrotizing pancreatitis managed with IVIg and I/V methylprednisolone, which later on developed walled-off pancreatic necrosis (WOPN) required surgical intervention. Conclusion: It is important to look for etiology of pancreatitis and in present era MIS-C is important cause. Clinicians should always search for this etiology as management is entirely different from other causes of pancreatitis. Clinical significance: We describe first case of necrotizing pancreatitis with walled-off pancreatic necrosis requiring surgical intervention associated with MIS-C. Management required IVIg and/or steroids which is entirely different from pancreatitis associated with other etiologies.

Severe immune deficiencies are often fatal in young childhood unless recognized and treated with a hematopoietic stem cell transplant (HSCT) timely. The majority of the immune deficiencies are monogenic diseases and may affect multiple children in the affected family. While diagnoses and treatment of the affected child are of immediate priority, preventing these diseases in subsequent pregnancies is paramount. In this paper, we discuss the importance and ways of antenatal detection of inborn errors of immunity (IEI) and present a few case scenarios highlighting the need to consider different modalities for the diagnosis of these diseases in the fetus.