Fig. 1.

Pathogenesis of Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS)/ Multisystem Inflammatory Syndrome in Children (MIS-C). Early infection (phase I) with SARS-CoV-2 is possibly to be asymptomatic or mildly symptomatic in children. The pulmonary phase (phase II) is severe in adults but is mild or absent in most affected children. The early infection seems to activate macrophage followed by the stimulation of T-helper cells. This in turn leads to ‘cytokine storm’ leading to a hyperimmune response (stage III). This immune dysregulation is related to inflammatory syndrome in affected children. Direct infection by SARS-CoV-2 virus is unlikely to involve in PIMS-TS/ MIS-C