A 12-year-old non-consanguineous girl with no medical history presented to the emergency department for a bilateral acute vision loss with conjunctival hemorrhage evolving for 2 days. The family reported that the child had poor compliance with the preventive measures against coronavirus disease 2019 (COVID-19) during the previous month while attending public places like school. Also, several cases of COVID-19 were confirmed within her schoolmates. The girl suffered from flu-like symptoms of a fever of 39 C associated with a runny nose, sneezing, a dry cough, and diarrhea 4 weeks before admission. At that time, the parents did not seek medical advice. The child received self-medication with antipyretics at home. Her flu symptoms resolved spontaneously within 7 days. After her hospital visit, the girl was admitted to the pediatric ward. She was hemodynamically stable. Vital signs were as follows: a body temperature of 37.1 C, a blood pressure of 120/60 mmHg, a pulse rate of 68 beats per minute, a respiration rate of 20 breaths per minute, and oxygen saturation level of 98%, and a capillary refilling time of 2 seconds. The urine dipstick found microscopic hematuria of 4x and proteinuria of 1x. The diuresis was 2.5 cc/kg/h. The child had no edema or signs of volume overload. The ophthalmological examination found a periorbital ecchymosis associated with a significant, diffuse, and bilateral subconjunctival hemorrhage (Figure 1a). The best-corrected distance visual acuity was 0.3 logMAR in the right eye and 0.4 LogMAR in the left eye. The anterior segment examination showed no inflammation. The fundoscopy revealed a bilateral serous retinal detachment (SRD) affecting predominantly the posterior pole. Retinal angiography showed a dye leakage of the juxta macular area with diffusion into the SRD bulla on both sides. Meanwhile, the spectral-domain optical coherence tomography (SD-OCT) found a bilateral SRD more extensive on the left side (Figure 1b and c). Evaluation for cells in the posterior vitreous was negative in both eyes. The remaining physical examination was unremarkable. Cerebral and facial computed tomography angiography was normal. Laboratory tests revealed an acute kidney injury, with urea nitrogen of 3.29 g/l, a creatinine of 68.4 mg/l, and an eGFR of 9 ml/min/1.73 m2. The girl had hyponatremia of 133 mmol/l, hypochloremia of 92 mmol/l, and hypocalcemia of 77 mg/l. Also, she had a metabolic acidosis, with a bicarbonate level of 14 mmol/l. The remaining plasma electrolytes were within the normal range, with potassium of 5 mmol/l and a phosphor of 50 mg/l. The 24 hours proteinuria and microalbuminuria levels were high (respectively 760 mg and 142.6 mg). On the other hand, albumin and protein levels were within the normal range. Urinalysis found leukocytic and hematic casts. Complete blood count found a neutrophilic leukocytosis of 13 294/mm3 and normal hemoglobin level and platelets count (11.8 g/dl and 233 000/mm3, respectively). Acute phase reactants were high, with a CRP of 118 mg/l, an ESR of 77 mm the first hour, ferritin of 272 ng/ml, and fibrinogen of 3.7 g/l. D-dimers and amylase were high (with 1.17 ng/ml and 56 ui/l, respectively). Meanwhile, PT was prolonged at 59%. Concurrently, the child had a normal aPTT level of 22.2 seconds with no hepatic cytolysis or cholestasis. Likewise, complement, CPK, and troponin levels were within the normal range. The echocardiography and the abdominal echography were normal. A kidney biopsy was performed and showed diffuse endocapillary glomerulonephritis. Direct immunofluorescence found deposits of IgG and C3 in the capillary walls. The epidemiological context (the COVID-19 pandemic), the telltale symptoms (the flu signs), as well as the results of the paraclinical examinations (showing features of inflammation with multisystemic involvement) made the diagnosis of PIMS-TS very likely. From this perspective, we performed SARS-CoV-2 laboratory tests. The RT-PCR on the nasopharyngeal swab was negative, while the SARS-CoV-2 serology on the blood sample found negative IgM antibody and positive IgG antibody. Negative serologies of CMV, EBV, HSV, HBV, HCV, and HIV eliminated another viral cause of this condition. Meantime, repeated blood cultures to look for a bacterial or fungal infection remained sterile. Furthermore, the ASLO and angiotensin-converting enzyme II levels were within the normal range, and the QuantiFERON TB-gold plus test was negative. No additional clinical signs suggested an autoimmune disease (eg, systemic lupus erythematous, Gougerot-Sjogren syndrome, juvenile systemic arthritis, Wegener granulomatosis, or polyarteritis nodosa). In this context, anti-nuclear antibodies, anti-DNA antibodies, rheumatoid factor, anti-SSA/SSB, anti-Rnp, and anti-nuclear anti-cytoplasmic antibodies were negative. Management consisted of starting pulses of methylprednisolone at 1 g/1.73 m2/day for 3 consecutive days, followed by oral prednisone at 2 mg/kg/day for the first 4 weeks. Evolution was marked by normalization of renal function, plasma electrolytes, acute phase reactants, neutrophils polynuclear count, amylase, and PT levels within 1 week. After 1 month of acute onset, the ophthalmological examination showed improved visual acuity with 0.05 logMAR in the right eye and 0.1 logMAR in the left eye. Also, there was a significant recovery of the subconjunctival hemorrhage on both sides (Figure 2a). As for the fundoscopy, there was a persistent SRD of the left eye, while the right eye was normal. The SD-OCT revealed a rapid remission and fast reduction of the SRD of the right eye, whose macular architecture was restored to normal (Figure 2b). Meanwhile, the SRD of the left eye had partially resolved (Figure 2c). That is when we started tapering oral steroids at a dose of 1 mg/kg/day. By the end of the second month, remission was complete. The best-corrected distance visual acuity was 20/20 in both eyes. There was a total regression of the subconjunctival hemorrhage (Figure 3a), the SRD on both sides, and a normal macular profile of both eyes on SD-OCT (Figure 3b and c). Withdrawing oral steroids was completed by the end of the third month of treatment. The child remains healthy and asymptomatic after a follow-up period of 5 months.