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

Abstract

Multisystem inflammatory syndrome in children (MIS-C) affects a small percentage of pediatric patients infected with COVID-19 and is characterized by fever, laboratory evidence of inflammation, multisystem involvement, and severe illness necessitating hospitalization. Skin findings are often present in these patients and while initially compared to Kawasaki disease, likely represent distinct phenomena and overall remain poorly characterized. In this retrospective review of 34 case reports and series, we identified cutaneous manifestations documented in 417 of 736 patients (57%) with MIS-C associated with COVID-19. “Rash” was the sole descriptor of skin findings in nearly half of patients. Case reports and smaller case series provided more detail, outlining a broad range of lesion morphologies (polymorphic, maculopapular, morbilliform, erythrodermic, urticarial, reticular, petechial, purpuric) in variable anatomic distribution. More thorough descriptions of dermatologic manifestations in patients with MIS-C are warranted to better characterize this syndrome, as they may lend important insight into pathogenic mechanisms of disease.

Prominent rash and multisystem inflammatory syndrome in a 29-year-old patient with COVID-19: a case report

“…Gastrointestinal symptoms, such as the abdominal pain and diarrhea experienced by our patient, are common [16]. Severe systemic inflammation, including various mucocutaneous findings, have been more recently described in adults [17,18]. How infection with SARS-CoV-2 leads to multisystem inflammation in both children and adults remains unclear.…”

An Observational Study of Mucocutaneous Manifestations among SARS-CoV-2 Patients from Three COVID-19 Dedicated Tertiary Care Centers

“…Outbreaks of Kawasaki-like illness have been reported amidst the pandemic. [ 35 36 ] We found two such cases in pediatric ICU, who had an uneventful recovery. Cases with urticarial vasculitis associated with MIS-C were also observed by us [ Figure 1 ].…”

Sixteen Weeks Later: Expanding the Risk Period for Multisystem Inflammatory Syndrome in Children

“…Neurological features have been reported to occur in a pooled mean proportion of 38.7% of patients with MIS-C and would include the myalgia, weakness, and mild headache seen in this patient [ 11 ]. About 57% of MIS-C cases describe dermatological findings involving a wide range of cutaneous manifestations to include polymorphic, maculopapular, morbilliform, erythroderma, urticarial, reticular, petechial, and purpuric with varying distribution on the body [ 12 ]. Her presentation with an urticarial, pruritic rash of the face initially before any other symptoms appears to be uncommon with only one of the cases reporting similar findings.…”