LAUSR

© 2020 Wolters Kluwer Health, Inc. All rights reserved. www.pidj.com | e473 Multisystem Inflammatory Syndrome Surveillance and COVID-19 in Latin America in the terminal ileum, and its relationship with terminal ileitis has been well documented. What is not clear, is whether appendicitis may occur as a complication of SARS-CoV-2 through similar proposed mechanisms related to the inflammation associated with viral entry or reactive lymphoid hyperplasia causing luminal obstruction. Acute appendicitis is known to be associated with Kawasaki disease, of which MIS-c shares many common clinical and pathologic features, possibly related to appendicular artery vasculitis. In Kawasaki disease, abdominal features may represent more severe disease. No fecoliths were found in any of the children requiring appendectomy, possibly supporting inflammation or vasculitis as pathologic mechanism. Where surgical emergencies are not managed in conjunction with pediatricians, surgeons should familiarize themselves with the features of MIS-c to facilitate early identification and referral of possible cases. The importance includes the impact on diagnosis of appendicitis, postoperative recovery, and the management of multisystem involvement, which differentiates this entity from the regular course of isolated acute appendicitis. Our experience suggests that, as with Kawasaki disease, pediatricians that diagnose MIS-c should be vigilant and continue to carefully evaluate children for surgical complications, including appendicitis and perforation, particularly if abdominal pain is part of the presenting complaint. Access to sophisticated imaging to differentiating appendicitis from terminal ileitis may be limited in some settings, but if there is doubt the most sophisticated available imaging should be sought. Our experience further highlights the suspected association between acute appendicitis, COVID-19, and MIS-c. This should always be considered particularly in children with clinical appendicitis who are PCR positive for SARS-CoV-2 at the time of presentation.