CHOP researchers describe range of rashes seen in MIS-C patients

In April 2020, pediatricians began to recognize a puzzling syndrome in children involving hyperinflammation that results in an array of symptoms, including fever, gastrointestinal upset, and rash. The syndrome, considered to be a post-infectious complication of SARS-CoV-2 infection, has been called multisystem inflammatory syndrome in children, or MIS-C. However, diagnosing the disease has posed challenges, as many of its symptoms, including rashes, are common in many other pediatric infections.

In a study published in Open Forum on Infectious Diseases, researchers at the Children’s Hospital of Philadelphia (CHOP) describe the range of rashes seen in MIS-C patients in their hospital through the end of July 2020, providing photos and information that could help doctors to diagnose future cases.

We hope that the information provided in this research letter will help general pediatricians and emergency department physicians who may be wondering if a fever patient requires further examination. Since some rashes associated with MIS-C are distinctive, we also imagine that these images could help many parents who are looking for signs that their child needs a quick assessment. “

Audrey Odom John, MD, PhD, Head of the Division of Pediatric Infectious Diseases at CHOP and lead author of the article

The research team analyzed the rashes associated with MIS-C in seven patients seen at CHOP. Although researchers did not observe a single defining rash associated with COVID-19, several types of rashes were common in these patients, both in appearance and location.

In terms of the location of the rashes, all of the patients in the study developed a rash on their lower body and five of the seven patients had a rash on the inside of their thighs. Rashes on the chest and upper limbs were also common, occurring in four out of seven patients.

More than half of the patients had small to medium ring plaques, which look like dime circles, on the chest and back. More than half of the patients in the study also developed purpura, tiny red spots, often in the center of the penny-shaped annular plaques.

While some patients developed a cherry red rash on the underside of their feet and the palms of their hands, this type of rash was seen in less than half of the patients in the study. Rashes on the face were rare, and the rashes rarely itchy.

“Depending on the age of the child, parents may not regularly look at the child’s chest, back, or thighs, but this is where the rashes associated with MIS-C tend to appear,” John said. “Since MIS-C is still largely an exclusionary diagnosis, parents and health care providers should look for rashes in these areas if the child has a fever that looks suspicious.