Mucocutaneous Manifestations of Multisystem Inflammatory Syndrome in Children During the COVID-19 Pandemic

Abstract

IMPORTANCETo date, no study has characterized the mucocutaneous features seen in hospitalized children with multisystem inflammatory syndrome in children (MIS-C) or the temporal association of these findings with the onset of systemic symptoms. OBJECTIVE To describe the mucocutaneous findings seen in children with MIS-C during the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City in 2020. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series was conducted of 35 children admitted to 2 hospitals in New York City between April 1 and July 14, 2020, who met Centers for Disease Control and Prevention and/or epidemiologic criteria for MIS-C. MAIN OUTCOMES AND MEASURES Laboratory and clinical characteristics, with emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The characterization of mucocutaneous features was verified by 2 board-certified pediatric dermatologists. RESULTS Twenty-five children (11 girls [44%]; median age, 3 years [range, 0.7-17 years]) were identified who met definitional criteria for MIS-C; an additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 years]) were included as probable MIS-C cases (patients met all criteria with the exception of laboratory test evidence of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients (29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6) being the most common findings. Recognition of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after the onset of fever. The duration of mucocutaneous findings varied from hours to days (median duration, 5 days [range, 0-11 days]). Neither the presence nor absence of mucocutaneous findings was significantly associated with overall disease severity. CONCLUSIONS AND RELEVANCEIn this case series of hospitalized children with suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous findings was identified. Despite their protean and transient nature, these mucocutaneous features serve as important clues in the recognition of MIS-C.

COVID-19 Pediatric Dermatology

“…Specifically, it is thought that MIS-C is a late or post-viral complication due to trends revealing a higher likelihood of SARS-CoV-2 antibody positivity compared to viral ribonucleic acid (RNA) detection. 27 , 28 , 29 , 30 Children who report milder viral symptoms before MIS-C onset support the notion of MIS-C being a later sequelae; the median time to onset has been reported at 25 days. 24 …”

“…MIS-C demonstrates a wide spectrum of cutaneous associations. Mucocutaneous findings are a component of MIS-C in 50-83% of children, 19 , 24 , 29 , 36 , 37 which are variable and polymorphic ( Table 1 ). Purpuric, targetoid, erythematous, retiform, reticular, livedoid, urticarial, scarlatiniform, papular, macular, maculopapular, desquamative, erythema multiform-like, and morbilliform exanthems have been described.…”

“…37 , 38 , 39 , 40 , 41 Eruptions may be generalized or localized, such as to the trunk, face, periorbital area, extremities, or diaper area. 29 , 38 , 40 , 41 In one series of 7 MIS-C children with cutaneous findings, 57% had lesions described as urticarial-like plaques, all had involvement of the lower extremities, and 29% experienced mild pruritis. 37…”

“… 29 , 38 , 40 , 41 In one series of 7 MIS-C children with cutaneous findings, 57% had lesions described as urticarial-like plaques, all had involvement of the lower extremities, and 29% experienced mild pruritis. 37…”

SARS-CoV-2 Infection and Disease Modelling Using Stem Cell Technology and Organoids

“…In addition, SARS-CoV-2 infection has been associated with a variety of clinical conditions, including a new multisystem inflammatory syndrome in older children, manifested by severe abdominal pain, cardiac dysfunction and shock [ 18 ], pulmonary fibrosis, neurological and neuropsychiatric complications (cerebrovascular events, encephalitis, Guillain Barré syndrome, altered mental status) [ 19 ], acute pancreatitis, coagulopathy, renal failure, diabetes, and dermatological lesions [ 20 , 21 ].…”