Oral manifestations of COVID-2019–related multisystem inflammatory syndrome in children: a review of 47 pediatric patients

Abstract

Background. Although much is still unknown about the full effects of COVID-19, literature from the early stages of the COVID-19 pandemic (spring and summer 2020) supports a postviral immunologic reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms.Methods. The authors conducted a retrospective review of pediatric patients with COVID-19 who were admitted to the Morgan Stanley Children's Hospital of NewYork-Presbyterian. Patients fulfilling the Centers for Disease Control and Prevention criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared with the presence of oral or oropharyngeal findings.Results. The mean (standard deviation) age of MIS-C patients was 9.0 (5.0) years (range, 1.3-20.0 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) had red or swollen lips, whereas only 5 (10.6%) had a strawberry tongue. Oral or oropharyngeal findings were associated significantly with the presence of systemic rash (P ¼ .04) and conjunctivitis (P ¼ .02).Conclusions. The presence of oral or oropharyngeal changes may be an early indicator of MIS-C and should be considered suggestive of MIS-C in the setting of COVID-19 infection.Practical Implications. Dental care providers may play an integral role both in the early detection of oral manifestations of MIS-C and in the identification of oral lesions in hospitalized patients with confirmed MIS-C.

Multisystem inflammatory syndrome in children with COVID-19

“…Multiorgan involvement is common in these patients, and cardiogenic or vasoplegic shock can occur in 32–76% of patients [ 1 , 7 , 11 , 27 , 28 , 32 ]. Patients may also present with mucous membrane involvement (27–76%), lymphadenopathy (6–16%), and swollen hands or feet (9–16%) [ 1 , 4 , 7 , 10 , 11 , 20 , [29] , [30] , [31] , [32] , [38] , [39] , [40] ]. Pleural effusions, pericardial effusions, and ascites can also occur in these patients [ 41 ].…”

“…The mainstay of treatment for MIS-C is immunomodulation in those with shock, cardiac involvement, or severe disease manifestations requiring intensive care unit admission [ 1 , 4 , [6] , [7] , [8] , 10 , 40 , 42 , 59 , 60 ]. While there are no prospective studies to date, expert recommendations using data extrapolated from KD advise intravenous immunoglobulin (IVIG) as first-line therapy in doses of 2 g/kg administered every 8–12 h [ 1 , 4 , [6] , [7] , [8] , 10 , 40 , 42 , [59] , [60] , [61] ]. Recent retrospective data have also suggested a potential benefit of early initiation of corticosteroids (prednisolone 2 mg/kg/day given intravenous or oral in 3 divided doses for 10 days), particularly in critically ill children and those on multiple vasoactive medications [ 1 , 4 , 7 , 20 , 43 ].…”

Oral mucosal lesions in patients with COVID-19: a systematic review

“…The most commonly reported oral lesion was oral ulceration which was reported in up to 47% (n = 27) of the cases in one study. 12 Other common oral mucosal changes included changes in the tongue including strawberry tongue, geographic tongue, fissured tongue and macroglossia which has even led to a terminology ‘covid tongue’, 13 , 14 , 15 , 16 with one study reporting these changes in up to 25% of the cases (n = 10). 16 Gingival manifestations included necrotic gingivitis and desquamative gingivitis.…”

Tongue ulcer in a patient with COVID-19: a case presentation

“…To that end, Bordea and colleagues report a systematic review of guidelines to provide safe and efficacious oral care during the COVID-19 pandemic [ 31 ]. A retrospective study of 47 multisystem inflammatory syndromes in children (MIS-C) positive pediatric patients, who tested positive for COVID-19 infection, concluded that dental care providers play an important role in the early detection of MIS-C and in the identification of oral lesions in MIS-C patients [ 32 ]. They posit, furthermore, that MIS-C incidence is likely to increase as the number of COVID-19 positive cases continues to grow.…”