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The article on coronavirus disease 2019 (COVID-19) related multisystem inflammatory syndrome in children reporting two clinical cases, published in this issue by Taffarel et al., describes the association of COVID-19 infection and critical disease in pediatric patients. In children, clinical manifestations of COVID-19 infection are usually mild to moderate; however, notwithstanding its low prevalence, multisystem inflammatory syndrome (MIS) should be taken into account due to its severity.1 Further knowledge regarding MIS based on clinical features, severity-associated factors, and therapeutic interventions, as described in the article, is essential for timely diagnosis and early treatment. Therefore, the case reports and literature review provided by the authors are extremely helpful in our daily clinical practice. Interestingly, as mentioned in the study, although these patients are critically ill, mortality rate is low. The overwhelming information on COVID-19 and the syndrome considered here (MIS) has led us to reflect on different aspects that, according to our understanding, should be mentioned in order to avoid possible confusion. In this regard, the first consideration is the relation between MIS and the clinical characteristics it has in common with Kawasaki disease (KD).2 European studies have reported a 30-fold increased incidence of KD compared to historical (pre-pandemic) data from the same time of year.3 These patients with KD (who meet the diagnostic criteria) did not present with features that were different from those widely known for KD. Nevertheless, there is a subgroup of older patients (>5 years) with more frequent gastrointestinal and neurological manifestations, myocarditis, hemodynamic failure, and abnormalities on laboratory tests (lymphopenia, thrombocytopenia, increased ferritin levels) associated with a more severe presentation, termed atypical KD.4,5 This subgroup of patients with KD is more likely to develop Kawasaki shock syndrome (approximately 10 % will develop KSS) or a phenotype similar to toxic shock syndrome.6 These two condit ions share c l inical and biochemical features with MIS. In addition, 25 % of patients defined as having MIS may meet the COVID-19-related cytokine and information storm: considerations regarding multisystem inflammatory syndrome in children