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Review
. 2021 Mar-Apr;97(2):116-139.
doi: 10.1016/j.jped.2020.08.007. Epub 2020 Sep 22.

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Pedro A Pousa  1 , Tamires S C Mendonça  1 , Eduardo A Oliveira  2 , Ana Cristina Simões-E-Silva  3
Affiliations
Review

Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Pedro A Pousa et al. J Pediatr (Rio J). 2021 Mar-Apr.

Abstract

Objective: The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children.

Source of data: An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as "Novel coronavirus" or "Novel coronavirus 2019" or "2019 nCoV" or "COVID-19" or "SARS-CoV-2" were searched on PubMed database, associated either with age filters or generic pediatric terms.

Summary of findings: A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non-pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki-like disease were also described.

Conclusions: Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease.

Keywords: COVID-19; Extrapulmonary; Kawasaki like-disease; Multisystemic inflammation; Pediatric; SARS-CoV-2.

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Figures

Fig. 1
Fig. 1
Flow diagram of study selection.
Fig. 2
Fig. 2
Summary and prevalence of extrapulmonary manifestations of COVID-19 in children.
Fig. 3
Fig. 3
Cross-sectional diagram of MIS-C and KD symptoms. Blue section of the diagram indicates symptoms related only to MIS-C. Gray section refers to symptoms common to both MIS-C and KD. White section indicates symptoms related only to KD. MIS-C, multisystem inflammatory syndrome in children; KD, Kawasaki disease; GI, gastrointestinal.
See this image and copyright information in PMC

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