Young Children Presenting With Fever and Rash in the Midst of SARS-CoV-2 Outbreak in New York

Wolfe, D.; Nassar, George N.; Divya, Kanneganti; Krilov, Leonard R.; Noor, Asif

doi:10.1177/0009922820941631

Cited by 8 publications

(7 citation statements)

References 9 publications

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“…No other features of MIS-C SARS-CoV-2 PCR was positive Inotropic support, tocilizumab, hydroxychloroquine, azithromycin, methylprednisolone Recovered Rivera-Figueroa et al 65 Case report Mississipi, USA 5-year male Incomplete Kawasaki with small global pericardial effusion but no CAA SARS-CoV-2 PCR was positive IVIg and aspirin Recovered Ng et al 66 Case report Leicester, UK 3 cases, Abdominal pain, tachycardia, hypotension, conjunctivitis, rash SARS-CoV-2 PCR was positive in 1 patient, SARS-CoV2 negative in 2 IVIg, methylprednisolone, and aspirin. 2 patients needed inotropic suppprt Recovered Regev et al 67 Case report Israel 16-year-old male Atypical Kawasaki disease, abdominal involvement cardiac dysfunction, small vessel vasculitis, and severe hypocomplementemia, ARDS rtPCR positive for nasopharyngeal swab IVIg, aspirin with methylprednisolone, inotropes Recovered Hutchison et al 68 Case report New York, USA 14 years, male MIS-C presentation with headache, confusion, and irritability Negative for rtPCR, positive serological evidence Corticosteroids, IVIg, anticoagulation Recovered Wolfe et al 69 Case report New York, USA 2 cases, 4-year male and 3-year female Fever rash, abdominal pain, erythematous rash in both children Positive for rtPCR for 1 patient IVIg, steroid, and aspirin Recovered Rosenzweig et al 69 Letter to the editor New York, USA 2 cases, 16 years male and 14 years female 1st child: flu-like illness and ITP. Other child: mixed AIHA Serology positive.…”

Section: Resultsmentioning

confidence: 99%

Systemic inflammatory syndrome in COVID-19–SISCoV study: systematic review and meta-analysis

et al. 2021

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BACKGROUND: There has been a recent upsurge in the cases of Multisystem inflammatory syndrome in children (MIS-C) associated with Coronavirus disease . We performed a systematic review and meta-analysis on the demographic profile, clinical characteristics, complications, management, and prognosis of this emerging novel entity. METHODS: Using a predefined search strategy incorporating MeSH terms and keywords, all known literature databases were searched up till 10th July 2020. The review was done in accordance with PRISMA guidelines and registered in PROSPERO (CRD4202019757). RESULTS: Of the 862 identified publications, 18 studies comprising 833 patients were included for meta-analysis. The sociodemographic profile showed male predilection (p = 0.0085) with no significant racial predisposition. A higher incidence of gastrointestinal symptoms (603/715, 84.3%), myocarditis (191/309, 61.8%), left ventricular dysfunction (190/422, 45.0%), pericardial (135/436, 31.0%) and neurological symptoms (138/602, 22.9%) was reported. Serological evidence of SARS-CoV-2 had higher sensitivity compared to rtPCR (291/800, 36.4% vs 495/752, 65.8%; p < 0.001). Coronary artery anomaly (CAA) was reported in 117/681 in 9 publications (17.2%). A total of 13 (1.6%) fatalities were reported. CONCLUSION: Clinicians need to be vigilant in identifying the constellation of these symptoms in children with clinical or epidemiologic SARS-CoV-2 infection. Early diagnosis and treatment lead to a favorable outcome.

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Section: Resultsmentioning

confidence: 99%

Systemic inflammatory syndrome in COVID-19–SISCoV study: systematic review and meta-analysis

et al. 2021

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“…Ocular involvement was reported in three other cases, one involving a 4 year old boy with polymorphic pattern: Bilateral nonpurulent conjunctivitis, strawberry tongue, erythematous lacy rash on the palms [98], and two cases with Kawasaki disease-like presentation [64,83].…”

Section: Ocular/periocular Involvementmentioning

confidence: 97%

“…Ocular involvement has been described most frequently in the form of conjunctivitis (n = 11), but also as eyelid dermatitis and conjunctivitis (n = 1) and eyelid dermatitis (n = 2) [64,66,76,80,81,83,98,113].…”

Section: Ocular/periocular Involvementmentioning

confidence: 99%

“…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%

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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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Young Children Presenting With Fever and Rash in the Midst of SARS-CoV-2 Outbreak in New York

Cited by 8 publications

References 9 publications

Systemic inflammatory syndrome in COVID-19–SISCoV study: systematic review and meta-analysis

Systemic inflammatory syndrome in COVID-19–SISCoV study: systematic review and meta-analysis

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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