Mucocutaneous symptoms common in pediatric COVID-19 hospitalizations

Pediatric patients who were hospitalized with COVID-19 often experienced mucocutaneous symptoms, according to a study.

“Chilblain lesions in healthy children and adolescents have received much attention; these lesions resolve without complications after a few weeks. Besides, other cutaneous manifestations of COVID-19 in children have been the matter of case reports or small case series,” David Andina-Martinez, MD, of the emergency department, Hospital Infantil Universitario Niño Jesús in Madrid, and colleagues wrote. “Nevertheless, the mucocutaneous manifestations in hospitalized children infected with SARS-CoV-2 and their implications on the clinical course have not yet been extensively described.”

This descriptive, analytical study included pediatric patients who were hospitalized with COVID-19 in one hospital in Madrid between March 1, 2020, and Nov. 30, 2020.

Of 50 patients, 21 (42%) had mucocutaneous symptoms, which included exanthem in 18 patients, conjunctival hyperemia without secretion in 17 patients and red cracked lips or strawberry tongue in nine patients.

Ten patients were admitted to the PICU, and six of those patients had mucocutaneous symptoms.

Older children generally showed more mucocutaneous signs than younger children, and when adjusted for age and gender, patients with mucocutaneous symptoms were more likely to be admitted to the PICU (OR = 10.24; 95% CI, 2.23-46.88; P = .003).

Eighty-six percent of patients were determined to have multisystem inflammatory syndrome in children (MIS-C), described as a patient younger than 21 years old with fever, laboratory evidence of inflammation and evidence of clinically severe illness with multisystem organ involvement, as well as a positive SARS-CoV-2 infection or exposure to a suspected or confirmed COVID-19 case.

“Mucocutaneous involvement is frequent in COVID-19 pediatric patients admitted to the hospital,” the authors wrote. “Most of the patients hospitalized with mucocutaneous symptoms fulfilled MIS-C criteria. As a result, patients with an exanthem or conjunctival hyperemia at admission have a higher probability of PICU admission and a larger length of stay than those patients without mucocutaneous symptoms.”