Conclusion:
This is the first reported pediatric case of COVID-19 related hyperinflammatory shock with cardiac dysfunction and associated focal myocarditis, suspected based on elevated cardiac-injury-related biomarkers, electrocardiographic and echocardiographic abnormalities, and confirmed using CMRI. A high index of suspicion for myocardial involvement should be maintained in children with COVID-19. Focal myocarditis can be concomitantly seen in these pediatric patients who present with hyperinflammatory syndrome related global cardiac dysfunction. If logistically feasible, CMRI should be considered in these pediatric patients as it may provide significant insights into possible mechanisms of cardiovascular involvement and allow for improved risk stratification.