Multisystem inflammatory syndrome and acute rheumatic fever coexisting in a child with prolonged fever

Fever is the most common and antique feature of disease especially in children. Although considered of benefit when is generated from infective causes, when it is prolonged or from non-infective origin it could be harmful. Here is reported the case of a nine-years old boy hospitalized for prolonged fever of unknown origin. A detailed examination revealed the co-existence of two immune mediated conditions in children, Multisystem Inflammatory Syndrome and acute Rheumatic Fever. A high index of suspicion should be maintained while evaluating a child for a systemic inflammatory disease due to COVID-19, it is imperative to consider other systemic disease of childhood or the coexistence of two disorders.