en عفونی کودکان Pediatric infection disease Case & Review Case & Review <div style="text-align: justify;"><span style="font-size:14px;"><span style="font-family:Tahoma;"><span style="line-height:2;"><strong>Background</strong>: Children generally are less contaminated by COVID-19 than other age groups, but multisystem inflammatory syndrome-children (MIS-C) can cause severe outcomes in some children. The information about MIS-C patient mortality is limited, and the cause of mortality may vary by geographical region. Therefore, we performed this case series study to report the clinical features and treatment of MIS-C patients associated with COVID-19 who died in selected referral hospitals in Iran.<br> <strong>Case Presentation</strong>: We presented 9 cases of deceased MIS-C patients hospitalized from March 2020 to September 2021. The median age of deceased patients was 89 months (interquartile range: 8-162 mo). Five patients (55%) were male. The COVID-19 reverse transcription polymerase chain reaction (PCR) or serology test was positive in 7 children (77%). About 80% of the patients had comorbidities, most commonly obesity. All the patients were febrile at admission, and 77.78% had a fever for over 5 days. Respiratory, cardiac, and gastrointestinal signs were the most common. On admission, 6 patients were transferred to the pediatric intensive care unit. All patients received intravenous immunoglobulin and steroids.&nbsp;<br> <strong>Conclusions</strong>: The most common organ failure was lung, heart, liver, and kidney, but the main cause of death was cardiopulmonary failure. Early diagnosis and management of MIS-C are necessary to prevent severe complications and death.</span></span></span></div> Mortality, Multisystem inflammatory syndrome, Child, COVID-19, Iran 231 244 http://jpr.mazums.ac.ir/browse.php?a_code=A-10-1109-1&slc_lang=en&sid=1 Mohammad Sadegh Rezai drmsrezaii@yahoo.com 100319475328460010163 100319475328460010163 No Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. Fereshteh Rostami-Maskopaee rostamiraha5@gmail.com 100319475328460010164 100319475328460010164 Yes Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran. Mohammad Reza Navaeifar dr.navaifar@gmail.com 100319475328460010165 100319475328460010165 No Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. Azin Hajialibeig 100319475328460010166 100319475328460010166 No Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. Maedeh Gooran rostamiraha5@yahoo.com 100319475328460010167 100319475328460010167 No Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran. Behzad Haghighi Aski haghighi.b@iums.ac.ir 100319475328460010168 100319475328460010168 No Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran. Ali Manafi Anari manafi.a@iums.ac.ir 100319475328460010169 100319475328460010169 No Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran. Eslam Shorafa shorafae@sums.ac.ir 100319475328460010170 100319475328460010170 No Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Seyedeh Narjes Abootalebi abootalebinarjes@yahoo.com 100319475328460010171 100319475328460010171 No Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.