Mucocutaneous findings could indicate MIS-C


Diagnosing multisystem inflammatory syndrome in children (MIS-C) has not always been easy. A new report indicates that mucocutaneous findings might aid in diagnosis.

Much is still needed to be uncovered regarding multisystem inflammatory syndrome in children (MIS-C). A report in JAMA Dermatology offers some insight into the mucocutaneous findings seen in the children who were hospitalized with the condition in New York City during the height of COVID-19 pandemic in the city.1

The researchers ran a retrospective case series of pediatric patients who were hospitalized for suspected MIS-C or Kawasaki disease from April 1, 2020, to July 14, 2020, at either New York University (NYU) Langone Health Hassenfeld Children’s Hospital or NYU Winthrop Hospital. They used the Centers for Disease Control and Prevention case definition of MIS-C and a patient was included in the report if the child was aged 21 years or younger and presented with fever, laboratory evidence of inflammation, and severe illness requiring admission; illness that involved at least 2 organ system; and no plausible alternative diagnosis. The mucocutaneous findings were characterized by 2 board-certified pediatric dermatologists through review of photographs, review of documentation, and in-person evaluation.

A total of 35 children were included in the report with 25 meeting the definitional criteria for MIS-C and 10 children who were probable MIS-C case. Polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive for 10 patients and SARS-CoV-2 immunoglobulin tests were positive for 19 patients. Among the 35 children, 29 showed mucocutaneous changes with the most common changes being conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue (n = 8), and malar erythema (n = 6). Identifying the mucocutaneous findings happened an average of 2.7 days following the onset of fever. The finding lasted between hours and days, with a median duration of 5 days. Overall severity of disease was not linked to either presence or absence of mucocutaneous findings.

The investigators concluded that a variety of mucocutaneous findings were seen in children who had suspected MIS-C. Although such findings may be short-lived, they could be a key clue to helping diagnose MIS-C in affected children.


1. Young T, Shaw K, Shah J et al. Mucocutaneous manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic. JAMA Dermatol. December 9, 2020. Epub ahead of print. doi:10.1001/jamadermatol.2020.4779

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