A dermatologic perspective on multisystem inflammatory syndrome in children

Abstract

As of May 2020, an emerging immune-mediated syndrome mainly affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault, with a delay of several weeks. This syndrome has been termed "multisystem inflammatory syndrome in children" (MIS-C) and is observed in association with the coronavirus disease 2019 (COVID-19). The phenotypes of presentation include several characteristic features, including prolonged fever, skin eruption, neck stiffness, and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequent but inconsistent, whereas respiratory distress is typically and notably absent. We have reviewed recently published data aiming to better understand MIS-C, with a focus on its mucocutaneous manifestations.

Fig. 1

7-year-old girl, diagnosed with MIS-C, presented with erythematous urticaria-like plaques on the neck and overlying lymphadenopathy.

Fig. 2

12-year-old boy, diagnosed with MIS-C, presented with erythematous macules and papules coalescing into patches and plaques, respectively, on the trunk and extremities. This patient also hadpalmar erythema as in Fig. 3.

Fig. 3

12-year-old boy, diagnosed with MIS-C, presented with bilateral palmar erythema (the same patient as in Fig. 2).