A dermatologic perspective on multisystem inflammatory syndrome in children

Abstract

As of May 2020, an emerging immune-mediated syndrome primarily affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault, with a delay of several weeks. This syndrome has been termed multisystem inflammatory syndrome in children (MIS-C), and is observed in association with the coronavirus disease 2019 (COVID-19). The phenotypes of presentation include several characteristic features, including prolonged fever, eruption, neck stiffness and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequently but inconsistent, while respiratory distress is typically, and notably, absent. We have reviewed recently published data aiming to better understanding MIS-C, with a focus on its mucocutaneous manifestations. Mucocutaneous manifestations of MIS-C: conjunctivitis, oral mucosal changes, rash. The rash of MIS-C is typically diffuse and non-specific. Mucocutaneous manifestations of MIS-C are more common in younger children. KD and MIS-C differ in mean age of onset, race predilection, and associated symptoms.

Oral lesions in paediatric patients with COVID-19 and Paediatric Inflammatory Multisystem Syndrome: a review

“… Study Design Data Collection Date Sample n= Age, y, Location of oral lesions Type of oral lesions PIMS-TS Ahmed et al (2020), USA [ 10 ] SR Jan–July 2020 662 (39 studies) Mean 9.3 ± 0.5 Lips, Tongue Cheilitis (n = 216, 32.6%) Tongue Swelling (n = 31, 4.7%) Yes Bhujel et al(2021) UK [ 3 ] SR Mar 2020 84 (3 studiesreported paediatric patients) Range 3 months to 20 years Tongue, lip Oral pseudomembranous candidiasis (n = 2, 2%) Geographic tongue (n = 1, 1%) Coated tongue (n = 2, 2%), Red or swollen lips (n = 23, 27%) Strawberry tongue= (n = 5, 6.0%), Oral cavity changes unspecified (n=16, 19.0%) Yes (2 studies) (Falah et al, 2020 & Halepas al. 2021) Naka et al (2021), USA [ 11 ] Review article Jan 2021 452 (8 case series) Median 8 to 12 Oral mucosa and lips Dry and red lips and/or other mucosal changes in 25%–87% in children with MIS-C (n=185 affected) Yes Rekhtman et al (2020), USA [ 12 ] Cohort May 2020 31 (M: 19, F:11) Range 1.75 to 16 Tongue, Lips MIS-C group: Lip fissuring (n=4, 21%), tongue papillitis (n=2, 11%) COVID-19 group: Lip fissuring (n=1, 8%) Yes Whittaker et al (2020), Europe & USA [ 13 ] CS Mar–May 2020 58 Median 9 Lips Mucous membrane changes and red cracked lips (n = 11, 25%) …”

“…The most commonly affected oral sites were the lips and tongue and the most commonly reported symptoms were cheilitis, dry and red mucosal membranes, and tongue swelling. The studies also identified ‘oral mucosal changes’ in a large number of the study population, however the specific changes were not mentioned and therefore cannot be compared to the rest of the data [ 11 ]. Two of the five studies included in this review were systematic reviews, the first reported on oral lesions in patients with COVID-19 [ 3 ] and the second one reported on PIMS-TS [ 10 ].…”

“…A review article by Naka et al [ 11 ] of recently published studies on PIMS-TS in Europe and the United States identified 13 large case series of which 8 reported on oral lesions. The sample size of these eight studies was 452, of which 185 had oral lesions reported.…”

COVID-19 and Dermatology

“…In the pediatric population, one interesting condition (multisystem inflammatory syndrome in children) is being increasingly reported; wherein the cutaneous manifestations have been found to simulate Kawasaki disease. [ 4 ]…”

COVID-19 and Dermatologist: A Scenario from Nepal

“…4 Multisystem inflammatory syndromes which simulate Kawasaki disease were commonly seen in the pediatric population. 5 There is scarcity of data regarding cutaneous manifestation of COVID-19 from Nepal, a case report of Erythema multiforme like lesion has been reported. 6 As the COVID-19 pandemic picked up the threads, many of the cutaneous manifestations reported could be explained by the "Baader-Meinhof phenomenon" which Date of Submission: 19 th June, 2021 Date of Acceptance: 30 th August, 2021 Date of Publication: 1 st October 2021 is a frequency illusion and regarded as cognitive bias in which, there is a tendency to notice more frequently after noticing for the first time leading to selection bias.…”