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Most children with multi-system inflammatory syndrome (MIS-C) had mucocutaneous findings, a small case series in New York City found.

Among 35 children, 29 with MIS-C exhibited these sequelae, with conjunctival injection, palmoplantar erythema, and lip hyperemia the most common, reported Vikash Oza, MD, of New York University Grossman School of Medicine, and colleagues, writing in a brief report in

Importantly, the authors noted, "mucocutaneous involvement was not associated with cardiac dysfunction, need for inotropic support, or intensive care unit admission, suggesting that mucocutaneous changes are not associated with disease severity in MIS-C."

Oza and colleagues examined records for 35 patients with suspected MIS-C or Kawasaki disease from April 1 to July 14. They used CDC criteria for MIS-C, meaning patients were age 21 or younger, presented with fever, laboratory evidence of inflammation, and severe illness requiring admission, with involvement of two or more organ systems and "no alternative plausible diagnosis." Confirmed SARS-CoV-2 positivity or exposure to the virus were not necessary for inclusion, as many patients "became infected without known exposures." Patients were evaluated for Kawasaki disease using American Heart Association criteria.

Included patients had a median age of 2, and 16 were girls. Twelve were Hispanic, 10 were Black, and 6 were white. Twenty-five patients met CDC criteria for MIS-C, and 10 probable MIS-C cases were also included.

Overall, 21 patients tested positive for SARS-CoV-2: 10 via PCR and 11 IgG-positive only.

Gastrointestinal involvement was seen in 31 patients, and five developed respiratory symptoms. All patients but one had elevated D-dimer, though none developed thromboembolic phenomena. Nineteen patients had cardiac involvement, and ten had abnormal echocardiogram findings. Of these 19 patients, five required inotropic support, or therapy to stabilize circulation.

Of the 29 patients with mucocutaneous findings, 21 had conjunctival injection, or enlargement of the conjunctival vessels in the eye, 18 had palmoplantar erythema, or reddening of the palms or the soles of the feet, and 17 had lip hyperemia, or reddening of the lips.

In addition, 13 had lip cracking, eight had "strawberry tongue," and seven had periorbital erythema and edema, or reddening and swelling around the eyes.

Patients with probable MIS-C were significantly more likely to exhibit conjunctival injection than patients with confirmed MIS-C and meet criteria for Kawasaki disease or incomplete Kawasaki disease, but there were no other significant differences between groups.

The authors said while 60% of the cohort met criteria for Kawasaki disease or incomplete Kawasaki disease, there were "unique findings" not typically seen in patients with Kawasaki disease, including marked periorbital edema and "erythema reminiscent of heliotrope rash."

Among the 29 patients with dermatologic manifestations, 19 had fever a mean of 2.7 days prior to the first mucocutaneous finding, but duration of these symptoms varied widely, from a few hours to as much as 11 days (median 5 days). Age did not seem to matter for development of particular mucocutaneous symptoms, Oza's group said.

Ten patients were admitted to the ICU, and stayed a median of 6 days. All patients were discharged home. By the time the study ended, 34 patients were seen for outpatient follow-up, with nine experiencing palmoplantar desquamation.

Limitations to the study included that infectious disease and rheumatology specialists made diagnoses of MIS-C, so patients where these services were not consulted may have been missed. Ten patients were included who did not test positive for SARS-CoV-2, though the authors attributed that to testing imperfections and presenting at different times during disease course.

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