**1. Introduction**

There is little data on clinical characteristics and outcomes with SARS-CoV-2 infection in children and adults with an immunocompromised status after heart transplantation [1–5]. Higher mortality was associated with COVID-19 in adult transplant recipients with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers [5]. It is not easy to extrapolate adult outcomes to pediatric heart transplant recipients because of higher comorbidities such as hypertension, obesity, and diabetes in adult patients. A six-year-old heart transplant recipient with additional significant co-morbidities, including severe hypoxic-ischemic injury, gastrostomy, tracheostomy, and mechanical ventilation dependency, presented with multi-system inflammatory syndrome children (MIS-C) with evidence for systemic inflammation and masquerade as acute cardiac allograft rejection that resolved rapidly with high-dose steroid tretament.
