COVID-19 Inflammatory Syndrome With Clinical Features Resembling Kawasaki Disease

Spencer, R C; Closson, Ryan C.; Gorelik, Mark; Boneparth, Alexis; Hough, Rebecca F.; Acker, Karen P.; Krishnan, Usha

doi:10.1542/peds.2020-1845

Cited by 13 publications

(17 citation statements)

References 31 publications

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“…We categorized the reported oral mucosa findings into three subgroups: KWL: Kawasaki‐like syndrome‐associated oral mucosa findings (cracked lips, dry lips, cheilitis with/without erythema of oral mucosa; Table 3). 11,13–16,19–21,25,28,30,32,35–39,41,44,45,48,49 OU: Ulcers in the oral mucosa (aphthous, herpetiform, multiple, single, necrotizing; Table 4). 17,18,22,24,26,27,29,33,40,42,43,46,49,50 M: Miscellaneous group (macular, papular, pustular, bullous, and overlapping cases; Table 5).…”

Section: Resultsmentioning

confidence: 99%

COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

et al. 2021

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Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is the virus responsible for coronavirus disease 2019 (COVID‐19), which manifests as a flu‐like respiratory infection affecting multiple organ systems, including the gastrointestinal system, central nervous system, cardiovascular system, skin, and mucosa. In this review, we investigated the literature on specific manifestations of COVID‐19 in the oral mucosa. An online literature search in PubMed, Scopus, Google Scholar, and Medline was conducted to retrieve relevant studies on confirmed COVID‐19 patients with oral mucosa findings published between December 31, 2019, and April 07, 2021. After an independent review by two authors, 39 articles considering 59 laboratory‐confirmed cases of SARS‐CoV‐2 infection were included in the final analysis. The most common finding, reported in 29 patients (43.9%), was Kawasaki‐like syndrome. In addition, oral ulcers including aphthous, hemorrhagic, and necrotic ulcers were reported in 24 patients (36.3%). Other lesions reported included pustules, macules, bullae, maculopapular enanthema, and erythema multiforme‐like lesions. Concomitant skin lesions were present in 60.6% of patients. Fever was reported in 86.2% of patients. Forty‐eight patients (76.1%) were hospitalized. Loss of taste and smell was present in 30.8% of the patients. A comprehensive understanding of the dermatologic manifestations of COVID‐19 can improve and facilitate patient management and referrals.

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Section: Resultsmentioning

confidence: 99%

COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

et al. 2021

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“…Atypical COVID-related cutaneous manifestations include: Generalized pruritus with no skin lesions or previous drug history (n = 8) [21], atypical erythema nodosum (n = 3) [77,88,92], atypical Sweet syndrome (n = 1) [95], Kawasaki disease-like presentation (n = 5) [64,83,90], and polymorphic patterns (n = 9) [20,22,38,67,76,98,99].…”

Section: Atypical Cutaneous Manifestationsmentioning

confidence: 99%

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

Conforti

Dianzani

Agozzino

et al. 2020

Biology

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There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.

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“…60 Finally, other atypical or polymorphic cutaneous manifestations have been described as atypical erythema nodosum, atypical Sweet syndrome, Kawasaki disease-like presentation, generalized pruritus and polymorphic patterns. [61][62][63][64][65][66][67][68][69][70]…”

Section: Acute Generalized Exanthematous Pustulosis (Agep) Erythema Multiforme (Em) and Other Polymorphic/atypical Reactionsmentioning

confidence: 99%

Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes

Farinazzo¹,

Dianzani²,

Zalaudek³

et al. 2021

CCID

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The incidence of coronavirus disease 2019 (COVID-19)-related skin manifestations has progressively grown, in parallel with the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. The available evidence indicates that cutaneous signs are heterogeneous and can be divided as follows: a) erythematous rashes, b) lesions of vascular origin, c) vesicular rashes, d) urticarial rashes, and e) acute generalized exanthematous pustulosis (AGEP), erythema multiforme (EM) and other polymorphic/atypical reactions. Most cutaneous manifestations appear simultaneously or after respiratory and/or systemic symptoms such as fever, even if rarely urticaria has been reported as the first sign of the disease. It has been proposed that erythematous and vesicular rashes, as well as urticaria, are the result of immunological activation against Sars-CoV-2, similarly to other viral exanthems; alternatively, reactivation or co-infection of herpesviruses and drug hypersensitivity represent possible etiologic diagnosis that has to be considered. Regarding lesions of vascular origin, ischemic ones are the result of systemic hypercoagulability established in severe infections, whereas chilblains seem to be linked to the type I-interferon massively produced to halt virus replication. AGEP is triggered by drugs, whereas EM could represent a delayed immune response to the virus or a hypersensitivity reaction to drugs elicited by the inflammatory process built to fight the infection. A further pathogenic hypothesis is that the virus, or its particles detected in the skin (particularly in endothelium and eccrine glands), could be responsible for certain skin reactions, including chilblains and EM. From the available data, it appears that chilblains are correlated with younger age and less severe disease, while ischemic manifestations occur in the elderly with severe infection. In conclusion, larger studies are needed to confirm the suggested pathogenetic mechanisms of COVID-19-related skin reactions and to determine the potential prognostic significance of each one.

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COVID-19 Inflammatory Syndrome With Clinical Features Resembling Kawasaki Disease

Cited by 13 publications

References 31 publications

COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

COVID‐19‐related oral mucosa lesions among confirmed SARS‐CoV‐2 patients: a systematic review

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

Synthesis of the Data on COVID-19 Skin Manifestations: Underlying Mechanisms and Potential Outcomes

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