Introduction: The novel SARS-CoV- 2 virus have rapidly spread in the past year throughout the world and became a pandemic. Pediatric cases of COVID-19 are often mild or asymptomatic, accounting for less than 1% of critical cases (Zimmermann P, 2020). Case presentation: We describe a case of a 13-year-old boy with COVID-19 who had an unusual presentation of the disease with hemoptysis, that subsequently developed multisystem inflammatory disease temporally associated with COVID-19, with decrease of T cell subpopulations, bacterial superinfection, necrotizing pneumonia, and spontaneous pneumothorax. This case is to provide details about less usual and very severe course of the COVID-19 disease for the clinicians who manage children with SARS-CoV-2 infection. Conclusion: Although uncommon, severe evolution of Covid-19 in pediatric patients should be taken into consideration and further clinical studies are needed asses the real impact on child health and to elucidate the best clinical and therapeutic approach.
