Mucocutaneous Symptoms of Multisystem Inflammatory Syndrome in Pediatric Patients

child mask COVID doctor
Close up of a mother and daughter having an appointment with the pediatrician
The mucocutaneous features seen in hospitalized children with MIS-C and how these findings are associated with the onset of systemic symptoms are characterized.

Mucocutaneous symptoms of multisystem inflammatory syndrome in children (MIS-C), a pediatric consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in patients hospitalized in New York City at the height of the coronavirus disease 2019 (COVID-19) pandemic were identified in a study published in JAMA Dermatology

Investigators conducted a retrospective case series of children admitted to 2 New York City hospitals from April 1 to July 14, 2020. The analysis included patients younger than aged 21 years with laboratory and clinical characteristics either proving known MIS-C or suggesting MIS-C.  There were 2 board-certified pediatric dermatologists to characterized mucocutaneous findings based on in-person evaluations, photographs, and review of documentation by pediatric rheumatology or infectious disease specialists.

Investigators analyzed data from 35 pediatric patients. The median age was 2 years (range, 0.2-17); 46% were girls, 34% were Hispanic, 29% were Black, and 17% were White.

Of the 35 patients who had either confirmed or suspected MIS-C, 29, 83% had mucocutaneous symptoms. Conjunctival injection (n=21), palmoplantar erythema (n=18), lip hyperemia (n=17), lip cracking (n=13), periorbital erythema and edema (n=7), strawberry tongue (n=8), and malar erythema (n=6) were the most common findings. Additional findings included scarlatiniform eruptions (n=5), morbilliform eruptions (n=3), urticarial eruptions (n=3), and reticulated eruptions (n=3). Investigators did not find a statistically significant difference in symptoms between patients aged younger than 3 years (n=17) vs patients aged older than 3 years (n=18).

Fever occurred a mean of 2.7 days (range, 1-7 days) before mucocutaneous findings were noted in most (n=19) patients. Symptom duration was highly variable, ranging from a few hours to 11 days, with a median of 5 days. A month after fever onset, 9 patients had palmoplantar desquamation.

Study limitations included the retrospective nature of the study, which potentially limited researchers’ ability to capture all mucocutaneous changes.

Investigators suggested that “mucocutaneous changes are not associated with disease severity in MIS-C” because they found that the symptoms were not associated with cardiac complications or the need for intensive care.

Although MIS-C and Kawasaki disease (KD) often overlap in their presentation, investigators noted that the cohort in this analysis exhibited symptoms unique to MIS-C and not seen in KD, including marked periorbital edema and erythema, prominent malar erythema, and reticulated erythematous eruptions.

Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.  


Young TK, Shaw KS, Shah JK, et al. Mucocutaneous manifestations of multisystem inflammatory syndrome in children during the COVID-19 pandemic. JAMA Dermatol. Published online December 9, 2020. doi:10.1001/jamadermatol.2020.4779