We report a case of an 8-year-old girl who underwent a SARS-CoV-2 infection manifesting with atypical symptoms spearheaded by abdominal discomfort and systemic inflammation and partially mimicking hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS), which however did not fulfill the HLH/MAS diagnostic criteria. In this case of what has since been described as Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-COV-2 (PIMS-TS) we documented excellent clinical response to immunosuppression with systemic corticosteroids and intravenous immunoglobulins. We show a detailed longitudinal development of neutrophil immunophenotype which suggests activation and engagement of neutrophils during PIMS-TS with compensatory contraction of the response and contra-regulation of neutrophil phenotype during recovery.

Department of Anesthesiology and Intensive Care Medicine 2nd Faculty of Medicine Charles University Prague and University Hospital in Motol Prague Czechia

Department of Children and Adult Rheumatology University Hospital in Motol Prague Czechia

Department of Immunology 2nd Faculty of Medicine Charles University Prague and University Hospital in Motol Prague Czechia

Department of Paediatrics and Adolescent Medicine Centre for Paediatric Rheumatology and Autoinflammatory Diseases 1st Faculty of Medicine General University Hospital Prague Charles University Prague Prague Czechia

Emergency Department for Children University Hospital in Motol Prague Czechia

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