question: AIMS & OBJECTIVES: With the atual coronavirus disease 2019 (COVID-2019) pandemic, pediatrics societies have been discrebing many manifestation and complications of this virus. One of then is the multissytem inflammatory syndrome that we observed in a 10-year-ond boy and pretend to report. METHODS: Report a multisystem syndrome COVID-19 associated case, in a terciary public hospital in São Paulo, Brazil, during the pandemic (may, 2020). The follow-up was based on papers published by the Brazilian Pediatric Society in May 2020, about to the diagnosis and treatment in question, as well British Pediatric society Guidelines (April, 2020), and WHO reports (May, 2020) RESULTS: As the mentioned studies, in the begining patient had persistent fever, abdominal pain and rash mimetizing Kawasaki's Disease. He went through apendicectomy due to suspected appendicitis and lymph nodes with inflammatory signs were removed. On the second postoperative day, he presented respiratory distress, cardiogenic shock, kidney injury, coagulation disorder, miocardiac disfunction, hypersignal in coronary artery. As the most cases reported, PCR for SARS-COV-2 was negative, however serology for COVID-19 positive. This patient received mechanical ventilation, vasoactive drugs, high spectre antibiotic therapy and as suggested on the new guidelines: two days of immunoglobulin and iniciatede long therapy with Acetyl Salicylic Acid. CONCLUSIONS: In the middle of a disease pandemic with worldwide repercussions, when pediatric patients are less affected than adults, this case report contributes to Pediatric Societies being alert and knowing how to recognize cases with serious and lethal possibilities in relation to COVID-19 and iniciate the right treatment, decreasing the complications associated.