Cutaneous findings in SARS-CoV-2-associated Multisystem Inflammatory Disease in Children (MIS-C)

This submission has open access
Submission ID :
ESPR218
Submission Type
Submission Topic
Abstract: :

Background/Objective: Multisystem Inflammatory Syndrome in Children (MIS-C), is characterized by fever, profound systemic inflammation, shock, and often rash after exposure to SARS-CoV-2. We describe the dermatologic manifestations of MIS-C at a single institution. Methods: All children admitted to our tertiary care, academic, pediatric medical center with concern for MIS-C per CDC criteria are evaluated by an expert multidisciplinary committee to reach diagnostic consensus. Skin findings were photographed and included in the secure electronic health record. The Children's Hospital of Philadelphia IRB deemed this exempt research and verbal informed consent was obtained for photograph use. Clinical characteristics were abstracted via chart review. Consent was obtained for 7 patients to participate in this project. Results: Patients with MIS-C exhibited a variety of cutaneous clinical findings. Palmar and plantar erythema were observed in 3/7 (43%) patients. While discrete lesions were noted in all body locations, lesions on the chest and upper extremities were common (4/7, 57%) and the lower extremities were uniformly involved (7/7 of patients). In particular, 5/7 patients (71%) had lesions of the proximal medial thigh. Two patients exhibited rash on or around the ears (2/7, 29%) and neck. Although mucosal changes were common (6/7, 86%), including lip changes, the remaining face was less frequently involved. A variety of erythematous lesions were observed, classified as urticarial, morbilliform, and livedoid. These skin changes were observed in patients with diverse skin tones and pigmentation. The most common lesions observed were small-to-medium annular plaques (taking on an urticarial appearance) in 57% (4/7) of patients, although morbilliform eruptions with coalescing papules to plaques and coalescing macules were also noted, each in one patient. Reticulated plaques and patches (taking on a livedoid appearance) were noted in 2 patients (29%). In one patient, rash did not occur until the 4th hospital day, following recrudescent fever after IVIG and steroids; the rash resolved with additional dose of IVIG.  Purpura were seen in 4 (57%) of 7 patients. Most commonly, purpura were noted in the center of annular (urticarial) plaques, mimicking the appearance of erythema multiforme-like lesions. Discussion: MIS-C, thought to be a post-infectious complication of SARS-CoV-2 infection, remains largely a diagnosis of exclusion as its clinical manifestations are common to many other pediatric infections. We find that no unique, stereotypic rash was observed in patients who were treated for MIS-C, although annular plaques in the proximal medial lower extremities were common. We note overlap between cutaneous findings of MIS-C and those observed in rickettsial illness, toxic shock, and viral exanthems, which continues to pose a significant diagnostic dilemma. We anticipate these images and descriptions will aid clinicians in the diagnosis of future cases.

Optional insertion of tables and or figures :
If the file does not load, click here to open/download the file.
If the file does not load, click here to open/download the file.
The Children's Hospital of Philadelphia
University of Pennsylvania
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia

Similar Abstracts by Type

Submission ID
Submission Title
Submission Topic
Submission Type
Corresponding Author
ESPR157
Clinical Research
Original science
Aditya Chhikara
ESPR302
Epidemiology
Original science
Natasha Jouk
ESPR74
Clinical Research
Original science
Alexandra Mazo
26 hits