9-day high-grade spiking postoperative fever in a child with acute appendicitis: facing clinical systemic disorders in surgery setting

When dealing with a postoperative persistent fever in a surgical patient, multisystemic inflammatory disorders must be kept in mind, recognized at an early stage and suddenly managed multidisciplinary. We report about a life-threatening condition which was unlikely to be seen in a surgical context before the pandemic: the newly defined “Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection” (PIMS) is suspected when a patient presents with consistent clinical features; In the 78% of patients, some COVID19 exposure can be documented. A paediatric case of hemophagocytic lymphohistiocytosis is reported (eventually falling into the PIMS entity), follo by a laparoscopic appendectomy for an acute gangrenous appendicitis. An alert to the community of pediatric surgeons is warranted, hopefully to be a hands-on update within the 2020 pandemic.