Mohammad Sadegh Rezai - Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Fereshteh Rostami-Maskopaee - Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
Mohammad Reza Navaeifar - Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Azin Hajialibeig - Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Maedeh Gooran - Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Behzad Haghighi Aski - Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
Ali Manafi Anari - Department of Pediatrics, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
Eslam Shorafa - Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Seyedeh Narjes Abootalebi - Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Children generally are less contaminated by COVID-۱۹ 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-۱۹ who died in selected referral hospitals in Iran. Case Presentation: We presented ۹ cases of deceased MIS-C patients hospitalized from March ۲۰۲۰ to September ۲۰۲۱. The median age of deceased patients was ۸۹ months (interquartile range: ۸-۱۶۲ mo). Five patients (۵۵%) were male. The COVID-۱۹ reverse transcription polymerase chain reaction (PCR) or serology test was positive in ۷ children (۷۷%). About ۸۰% of the patients had comorbidities, most commonly obesity. All the patients were febrile at admission, and ۷۷.۷۸% had a fever for over ۵ days. Respiratory, cardiac, and gastrointestinal signs were the most common. On admission, ۶ patients were transferred to the pediatric intensive care unit. All patients received intravenous immunoglobulin and steroids.  Conclusions: 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.

Mortality, Multisystem inflammatory syndrome, Child, COVID-۱۹, Iran