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Paediatric inflammatory multisystem syndrome (PIMS) is associated with SARS-CoV-2 infection in patients aged 19 years or below according to World Health Organization (WHO) criteria. The condition is characterised by fever, inflammation and organ dysfunction. PIMS mimics Kawasaki disease or toxic shock syndrome. As SARS-CoV-2 infection is a global pandemic, clinicians need to be aware of the conditions associated with it.
We present the case of 18-year-old woman who was admitted with multi-organ failure requiring admission to the intensive care unit. The differential diagnosis included toxic shock syndrome, Kawasaki disease and PIMS. The overall picture fit the criteria for PIMS but the patient had a negative polymerase chain reaction (PCR) test for SARS-CoV-2, which presented additional diagnostic difficulties. As the PCR test was negative, IgG antibodies against SARS-CoV-2 were measured to detect past infection and tested positive. The patient was diagnosed with PIMS as she met the WHO criteria after other differential diagnoses were excluded. She was successfully treated with methylprednisolone and intravenous immunoglobulin (IVIG).

Background: Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC. 
Case report: We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response.<br />
Conclusion: This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients.