Cutaneous manifestations in paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome-coronavirus 2 infection

Paediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection (PIMS-TS) has been defined by the Royal College of Paediatrics and Child Health as 'a child presenting with persistent fever, inflammation and evidence of single or multi-organ dysfunction' (https://www rcpch ac uk/resources/guidance-paediatric-multisystem-inflammatory-synd rome-temporally-associated-covid-19-pims) We describe the skin manifestations in 17 paediatric patients presenting from 14 March to 18 May 2020 to a single institution with features of PIMS-TS Common presenting symptoms in these 17 children included fever, rash and gastrointestinal symptoms Less common presentations included cough, epistaxis, arthralgia, headache and respiratory symptoms and were only present in one patient Median age at presentation was 11 years (range 1-16), and the male-to-female ratio was 1 8 : 1 The majority of patients were black, Asian and minority ethnic (BAME);nine were of Afro-Caribbean descent, three were white, two were Turkish, one was Albanian, one was Indian and one was Hispanic Within this group, nine (53%) presented with a skin rash, eight (47%) with conjunctival involvement and three (18%) with cheilitis The time of onset of cutaneous disease was variable, but most patients presented with a rash at admission or within a few days of admission The rash was polymorphous, but the most common skin presentations were a maculopapular eruption and fixed urticaria, particularly on the trunk and limbs In addition, acral presentations were seen with erythematous oedematous ears and fingers The but it may represent an antibody or immune complexmediated postinfectious inflammatory syndrome (Verdoni L, Mazza A, Gervasoni A et al An outbreak of a severe Kawasaki -like disease at the Italian epicentre of the SARS CoV-2 epidemic: an observational cohort study Lancet 2020;Epub ahead of print) As dermatologists collate databases of images and histopathology of skin disease with this new virus, SARS-CoV-2, a clearer picture of the pathophysiology of this disease should emerge We propose that in any child presenting with persistent fever, rash and evidence of systemic inflammation, PIMS-TS should be considered, and urgent specialist referral sought, in light of the serious cardiac complications that may arise Further investigation is needed into the apparent higher rate of PIMS-TS in BAME children and the association with SARS-CoV-2 infection