Multisystem inflammatory syndrome in children related to COVID‐19: A New York City experience

Abstract

In December 2019, the 2019 novel coronavirus disease (COVID‐19) caused by Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) first emerged in Wuhan, China. This has now spread worldwide and was declared a pandemic by March 2020. Initially, the pediatric population was described as low risk for severe COVID‐19. However, reports have emerged recently of cases of COVID‐19 in children with a systemic inflammatory disease, with features that overlap with Kawasaki Disease (KD). We describe the first 15 cases with multi‐system inflammatory syndrome in children (MIS‐C), temporally related to COVID‐19, who presented for care to a tertiary pediatric referral center in New York City. We discuss the disproportionate burden of disease among Hispanic/Latino and black/African‐American ancestry, the distinct cytokine signature across the disease spectrum (IL‐1/IL‐6), and the potential role and pathogenesis of SARS‐CoV‐2 in this new clinical entity. This article is protected by copyright. All rights reserved.

Dermatologic manifestations of COVID-19-associated multisystem inflammatory syndrome in children

“…We identified a total of 34 case series 3 , 6 , 7 , 8 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 and case reports 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 published between May and July 2020 that mention dermatologic findings in 736 unique children with MIS-C. Cutaneous manifestations were present in 417 of 736 patients (57%). Fifteen (44%) of these articles state “rash” as the sole descriptor of skin findings.…”

A dermatologic perspective on multisystem inflammatory syndrome in children

“…Because MIS-C is thought to be an immune-mediated secondary response to the virus, COVID PCRs are usually negative at the time of the illness, and antibodies are positive in the majority of cases. 11 , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] Because diagnostic criteria for this condition are generally very broad, there is a significant challenge in identifying which patients falling under these diagnostic criteria are ‘true’ MIS-C. 22 (See Fig. 1 , Fig.…”

“…COVID PCR positivity ranged from 13% – 50%, while antibody positivity ranged from 75%–100%. [10] , [11] , [12] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , 23 , 24 …”

“…Multiple larger case series published in the recent months [10] , [11] , [12] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , 23 , 24 focus on characterizing and understanding MIS-C. Each case series has identified children who met criteria for MIS-C and described the cutaneous findings with which they presented. The following descriptive terminology was used to describe the skin findings: “conjunctivitis,” “eruption,” “red/cracked lips,” lips/oral cavity changes,” “cheilitis,” “extremity changes,” or “hand/feet edema”.…”

“…19 Looking at all the thirteen-case series presented in Table 3 , the percentage of children diagnosed with MIS-C who developed mucocutaneous findings included: conjunctivitis 27% – 93%, oral mucosal changes 25% – 87%, eruption 47% - 81%, and hand/feed erythema and edema 27% - 68%. Table 4 summarizes the top mucocutaneous manifestations of children with MIS-C. [10] , [11] , [12] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , 23 , 24 The skin findings associated with MIS-C tend to be more common in younger children and decrease with age. 87% of children between 0–5 years old had mucocutaneous findings, compared to only 61.5% of those 13–20 years old.…”