Mucocutaneous manifestations may signal COVID-induced inflammatory disease in children

Key takeaways:

• Multisystem inflammatory syndrome in children presents itself 2 to 6 weeks after COVID-19 infection.
• Rashes, bilateral conjunctivitis and mucocutaneous inflammation along with other symptoms can aid diagnosis.

NEW YORK — Children that contracted COVID-19 are at risk for developing multisystem inflammatory syndrome, which can present cutaneously, according to a poster presentation here.

According to the CDC, multisystem inflammatory syndrome in children (MIS-C) is a rare condition that usually occurs 2 to 6 weeks after a patient, aged 21 years or younger, contracts COVID-19.

“This is a new disease that came out with COVID,” Bashir Imam, MD, a pediatrician at the University of Pittsburgh Medical Center and an author of this study, told Healio. “Children who got COVID were coming into the hospital with a lot of inflammation. ... Nobody knew what was going on.”

Manifestations of the disease involve multiple organs including the heart, lungs, kidneys, brain, eyes, gastrointestinal tract and the skin. This disease can be fatal but, with proper diagnosis, can also be treated.

Due to the mucocutaneous manifestations of the disease, dermatologists can assist in the diagnosis process. Therefore, in this study, Imam and colleague Sadaf Kheyrodin, BS, of the University of Manitoba, conducted a comprehensive literature search of studies that included MIS-C diagnoses and treatments to determine whether all individuals exhibiting mucocutaneous manifestations are positive for MIS-C and if there is a pattern in these symptoms.

Results showed that of 126 children that fit the criteria for MIS-C, 74% of them had mucocutaneous signs including nonspecific eruption (59%), bilateral conjunctivitis (55%), changes to their oral mucosa (42%) and alterations to their periphery extremities (37%).

The literature review also found many key-terms that were used to describe these manifestations such as “conjunctivitis,” “rash,” “red/cracked lips,” “lips/oral cavity changes,” “cheilitis,” “extremity changes,” and “hand/foot edema.”

Due to the incidence rates of this disease, the CDC and WHO recently published their own sets of MIS-C diagnostic criteria in January of 2023 and May of 2020, respectively. Along with the cutaneous manifestations of the disease, these guidelines discuss the multi-organ signs and symptoms as well.

“Chances are if you have these mucocutaneous symptoms, plus a fever and the patient is under 21 years ... you should consider MIS-C,” Imam told Healio.

References:

• For parents: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. https://www.cdc.gov/mis/mis-c.html. Updated Jan. 3, 2023. Accessed Oct. 7, 2023.
• Multisystem inflammatory syndrome in children and adolescents with COVID-19. https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. Updated May 15, 2020. Accessed Oct. 7, 2023.