Mucocutaneous Manifestations in Hospitalized Children with COVID-19.

Abstract Background The cutaneous manifestations in hospitalized children infected with SARS-CoV-2 have not been studied systematically. Objective To describe the mucocutaneous involvement in pediatric patients with COVID-19 admitted in a pediatric institution in Madrid (Spain), a most prevalent COVID-19 zone in Europe. Methods A descriptive, analytical study of a series of 50 hospitalized children with COVID-19 from March 1 to November 30, 2020 was carried out. Results Twenty-one patients presented with mucocutaneous symptoms: maculopapular exanthem (18), conjunctival hyperemia (17) and red cracked lips or strawberry tongue (9). Eighteen patients fulfilled criteria for Multisystem Inflammatory Syndrome in Children (MIS-C). Patients with mucocutaneous signs tended to be older than those without skin signs and presented at the Emergency Department with poor general status and extreme tachycardia. Patients with mucocutaneous involvement also had higher C-reactive protein and D-dimer levels and lower lymphocyte counts. Mucocutaneous manifestations pose a higher risk of PICU admission (odds ratio 10.24, 95% confidence interval: 2.23-46.88; P=0.003). Conclusion Mucocutaneous involvement is frequent in COVID-19 pediatric hospitalized patients. Most of the patients with mucocutaneous symptoms fulfilled MIS-C criteria. As a result, patients with an exanthem or conjunctival hyperemia at admission have a higher probability of PICU admission than those patients without mucocutaneous symptoms.