BACKGROUND: Despite the availability of effective vaccines, enteric fever continues to impart considerable morbidity in developing countries, especially among children. Coronavirus disease-2019 (COVID-19) has changed the approach to acute febrile illness in children since the onset of the pandemic. The similarities of complicated enteric fever and the multisystem inflammatory consequence of COVID-19 warrant discussion as elucidated in the case report here.

CASE PRESENTATION: A previously healthy 11-year-old girl was referred to our centre with enteric fever with mucosal inflammation followed by encephalopathy, cytopenia, elevated inflammatory markers, rhabdomyolysis. Although she was not vaccinated, she had antibodies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). She responded to intravenous ceftriaxone and intravenous immunoglobulin infusion.

CONCLUSIONS: The clinical overlap among infection-associated hemophagocytic lymphohistiocytosis, multisystem inflammatory syndrome in children and Kawasaki disease represented a diagnostic challenge. Knowledge of these entities and their complications is essential to aid in early diagnosis and appropriate timely management.