multisystem inflammatory syndrome mortality following covid-19 in iranian children: a case series and literature review

Background: children generally are less contaminated by covid-19 than other age groups, but multisystem inflammatory syndrome-children (mis-c) can cause severe outcomes in some children. the information about mis-c patient mortality is limited, and the cause of mortality may vary by geographical region. therefore, we performed this case series study to report the clinical features and treatment of mis-c patients associated with covid-19 who died in selected referral hospitals in iran.case presentation: we presented 9 cases of deceased mis-c patients hospitalized from march 2020 to september 2021. the median age of deceased patients was 89 months (interquartile range: 8-162 mo). five patients (55%) were male. the covid-19 reverse transcription polymerase chain reaction (pcr) or serology test was positive in 7 children (77%). about 80% of the patients had comorbidities, most commonly obesity. all the patients were febrile at admission, and 77.78% had a fever for over 5 days. respiratory, cardiac, and gastrointestinal signs were the most common. on admission, 6 patients were transferred to the pediatric intensive care unit. all patients received intravenous immunoglobulin and steroids. conclusions: the most common organ failure was lung, heart, liver, and kidney, but the main cause of death was cardiopulmonary failure. early diagnosis and management of mis-c are necessary to prevent severe complications and death.