Mucocutaneous disease and related clinical characteristics in hospitalized children and adolescents with COVID-19 and multisystem inflammatory syndrome in children

Abstract

Background Little is known about mucocutaneous disease in acutely-ill children and adolescents with COVID-19 and MIS-C. Objective To characterize mucocutaneous disease and its relation to clinical course among hospitalized patients with COVID-19 and MIS-C. Methods Descriptive cohort study of prospectively and consecutively hospitalized eligible patients between May 11, 2020 and June 5, 2020. Results In COVID-19 patients, 4/12 (33%) had rash and/or mucositis, including erythema, morbilliform pattern, and lip mucositis. In MIS-C patients, 9/19 (47%) had rash and/or mucositis, including erythema, morbilliform, retiform purpura, targetoid and urticarial patterns, along with acral edema, lip mucositis, tongue papillitis, and conjunctivitis. COVID-19 patients with rash had less frequent respiratory symptoms, PICU admission, and invasive ventilation, as well as shorter stay (vs COVID-19 without rash). MIS-C patients with rash had less frequent PICU admission, shock, ventilation, as well as lower levels of CRP, ferritin, D-dimer, and troponin (vs MIS-C without rash). Neutrophil-to-lymphocyte ratio was similar for patients with and without rash in both groups. None of the MIS-C patients met criteria for Kawasaki disease. Limitations Small sample sizes. Conclusions Mucocutaneous disease is common among children and adolescents with COVID-19 and MIS-C. Laboratory trends observed in patients with rash may prognosticate a less severe course.

Mucocutaneous manifestations in children hospitalized with COVID-19

“…16,17 Conjunctival hyperemia appeared in practically the same proportion as the exanthem in our series and was a better independent predictor of PICU admission than the exanthem itself. Although in adults, it has received little attention, it should be considered as an alarm sign in children with suspected or confirmed COVID-19, as it has been frequently described in patients with MIS-C. 5,6,16,17 Our center is located in one of the regions most impacted during the pandemic in Europe. Although the fact of being a single-institution study is a limitation, we think the population is representative and offers a large cohort of hospitalized pediatric patients with COVID-19 and mucocutaneous involvement.…”

“…This is a higher rate than reported in other studies of patients with this condition, which described percentages from 47% to 83%. 5,6,16,17 Because this syndrome usually requires PICU admission, 16 the presence of exanthem or conjunctival hyperemia in our series is an independent predictor of PICU admission in hospitalized pediatric patients with COVID-19. A similar conclusion was reached regarding with gastrointestinal manifestations, probably due to the same underlying explanation.…”

“…4 As our investigation was entirely focused on the cutaneous manifestations of COVID-19, we made efforts to include data on these findings that other registries may have missed. In fact, the only previous study focused on hospitalized pediatric intensive care unit RT-PCR: reverse transcriptase polymerase chain reaction pediatric patients with mucocutaneous disease was by Rekhtman et al, 16 who described the same proportion of mucocutaneous involvement (42%).…”

Clinical Patterns and Morphology of COVID-19 Dermatology

“…Children with COVID-19 and skin manifestations carry an overall better prognosis than those without. 117 …”

A response to “Mucocutaneous disease and related clinical characteristics in hospitalized children and adolescents with COVID-19 and multisystem inflammatory syndrome in children’’

“…To the Editor: I read with great interest the article by Rekhtman et al 1 which describes the association between mucocutaneous disease and clinical course among hospitalized children and adolescents with COVID-19 and multisystem inflammatory syndrome in children (MIS-C) in dermatology practice. First, I thank the authors for drawing attention to MIS-C findings.…”