Speaker clarifies multisystem inflammatory syndrome in children with COVID-19
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Dermatologists can have a critical role in diagnosing multisystem inflammatory syndrome in children, a severe postinfectious complication of COVID-19, according to a speaker at South Beach Symposium Medical Dermatology Summit.
“The mucocutaneous findings are seen in up to 74% of kids, so it’s highly prevalent, and they can even precede the onset of fever, so we may be seeing these things before kids present with other symptoms that may prompt their pediatrician to consider this diagnosis,” Andrea Maderal, MD, said during the presentation.
Multisystem inflammatory syndrome in children (MIS-C) occurred weeks after infection with COVID-19 in published studies. Although it shares features with Kawasaki disease, there are several important distinctions.
“The presentation tends to be quite polymorphous, though one thing that is pretty regularly seen is a peripheral distribution, so you really want to look for acral involvement, look for that acral edema or erythema,” Maderal said.
Lip involvement is common, while eye and tongue involvement — including the strawberry tongue frequently reported in Kawasaki disease — is less common. Conversely, patients with MIS-C have more frequent gastrointestinal involvement compared with Kawasaki disease, she said.
Patients with MIS-C can also have “significant facial erythema with an almost erythema infectiosum-like appearance” along with “significant periorbital erythema and edema as well as widespread livedo-like lesions and almost scarlatiniform eruptions,” Maderal said.
Among patients with MIS-C, those with rash had “less ICU admission, less shock and lower inflammatory markers overall, so rash in our kids here is a good prognostic indicator,” she said.
The reason why some patients develop MIS-C and others do not “is still unclear and is being studied,” Maderal said. However, there are racial and ethnic disparities in MIS-C incidence. According to Maderal, Black and Hispanic children are overrepresented in the patient population.