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Recently, there has been a rise in a new inflammatory condition termed paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PMIS-TS). We are yet to understand significant risk factors, disease progression and prognosis in children affected. We describe a case of a 9-year-old boy who tested positive concurrently for the SARS-CoV-2 virus 4\u2009weeks apart. He presented with a 2-day history of fever, abdominal pain, headache and diarrhoea. Initial investigations supported PMIS-TS and he went on to develop atypical Kawasaki disease. With no results to differentiate between his positive results, we question whether he remained positive throughout or recovered with reactivation of the virus. There are reports of reactivation in adults but none in children. There are also no reports of children remaining positive for such a prolonged period, which raises public health concerns.<\/jats:p>","DOI":"10.1136\/bcr-2020-237194","type":"journal-article","created":{"date-parts":[[2020,9,15]],"date-time":"2020-09-15T17:28:06Z","timestamp":1600190886000},"page":"e237194","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Paediatric case of prolonged COVID-19 manifesting as PMIS-TS and atypical Kawasaki"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7564-6728","authenticated-orcid":false,"given":"Mike","family":"Masih","sequence":"first","affiliation":[{"name":"Paediatric Department, Wrexham Maelor Hospital, Wrexham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Moll","sequence":"additional","affiliation":[{"name":"Paediatric Department, Wrexham Maelor Hospital, Wrexham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naila","family":"Raza","sequence":"additional","affiliation":[{"name":"Paediatric Department, Wrexham Maelor Hospital, Wrexham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,9,15]]},"reference":[{"key":"2025082801313176000_13.9.e237194.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2006100"},{"key":"2025082801313176000_13.9.e237194.2","doi-asserted-by":"crossref","unstructured":"Williamson E , Walker A , Bhaskaran K , et al . OpenSAFELY: factors associated with COVID-19-related Hospital death in the linked electronic health records of 17 million adult NHS patients. medRxiv 2020.","DOI":"10.1038\/s41586-020-2521-4"},{"key":"2025082801313176000_13.9.e237194.3","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1016\/S0140-6736(20)31094-1","article-title":"Hyperinflammatory shock in children during COVID-19 pandemic","volume":"395","author":"Riphagen","year":"2020","journal-title":"The Lancet"},{"key":"2025082801313176000_13.9.e237194.4","unstructured":"Rcpch.ac.uk . RCPCH online resources, 2020. Available: https:\/\/www.rcpch.ac.uk\/sites\/default\/files\/2020-05\/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf [Accessed 23 May 2020]."},{"key":"2025082801313176000_13.9.e237194.5","unstructured":"Picsociety.uk . PICS news, 2020. Available: https:\/\/picsociety.uk\/wp-content\/uploads\/2020\/04\/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf [Accessed 23 May 2020]."},{"key":"2025082801313176000_13.9.e237194.6","unstructured":"Emergency.cdc.gov . Centers for disease control and prevention: resources for emergency health professionals, 2020. Available: https:\/\/emergency.cdc.gov\/han\/2020\/han00432.asp [Accessed 23 May 2020]."},{"key":"2025082801313176000_13.9.e237194.7","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s40272-019-00367-1","article-title":"Macrophage activation syndrome and secondary hemophagocytic lymphohistiocytosis in childhood inflammatory disorders: diagnosis and management","volume":"22","author":"Henderson","year":"2020","journal-title":"Paediatr Drugs"},{"key":"2025082801313176000_13.9.e237194.8","unstructured":"European Centre for Disease Prevention and Control . Ecdc publications and data, 2020. Available: https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf [Accessed 5 Jun 2020]."},{"key":"2025082801313176000_13.9.e237194.9","unstructured":"Evelinalondon.nhs.uk . South Thames retrieval service: clinical guidelines and drug calculators, 2020. Available: https:\/\/www.evelinalondon.nhs.uk\/resources\/our-services\/hospital\/south-thames-retrieval-service\/pims-ts-paediatric-multisystem-inflammatory-syndrome-temporally-associated-with-sars-cov2.pdf [Accessed 5 Jun 2020]."},{"key":"2025082801313176000_13.9.e237194.10","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2020.1948","article-title":"Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units","author":"Shekerdemian","year":"2020","journal-title":"JAMA Pediatr"},{"key":"2025082801313176000_13.9.e237194.11","doi-asserted-by":"crossref","unstructured":"Morand A , Urbina D , Fabre A . 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