To the Editor, The coronavirus disease 2019 appears to affect proportionally fewer children than adults and with a less severe clinical presentation. However, during the COVID-19 pandemic, a new childhood disorder has emerged worldwide characterized by fever, elevated inflammatory markers, and organ dysfunction (1, 2) . A case definition was published in April 2020 by The Royal College of Paediatrics and Child Health in the United Kingdom, and was named "pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)", or PIMS-TS. World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have subsequently also published their own case definitions.
We describe the recent experience with five patients affected by this condition from April 28 CMRI did not show any myocardial damage in this series. CMRI is considered a highly sensitive technique to evaluate myocardial injury. Although the number of patients in this series was small, heart dysfunction did not seem secondary to myocardial viral injury in these children.
An alternative hypothesis is that the exaggerated inflammatory response observed in these children with PIMS-TS could be the cause of the heart dysfunction. Heart. 2020; heartjnl-2020 -317186. doi:10.1136 /heartjnl-2020 J o u r n a l P r e -p r o o f 