Oral manifestations of COVID-19 related multi-system inflammatory syndrome in children: a review of 47 pediatric patients

Halepas, Steven; Lee, Kevin C.; Myers, Aaron; Yoon, Richard K.; Chung, Wendy; Peters, Scott M.

Background Although much is still unknown about the full effects of COVID-19, recent literature supports a post-viral immunological reaction resulting in a multisystem inflammatory syndrome in children (MIS-C). The purpose of this study was to report the rates of documented oral and oropharyngeal manifestations among these patients and to determine the association of these findings with other MIS-C symptoms. Methods This was a retrospective review of COVID-19 positive pediatric patients admitted to the Morgan Stanley Children’s Hospital of NewYork-Presbyterian (MSCHONY). Patients fulfilling the Centers for Disease Control and Prevention (CDC) criteria for MIS-C were included in this study. The documented signs, symptoms, and laboratory values were collected and compared against the presence of oral or oropharyngeal findings. Results The mean age of MIS-C patients was 9.0 ± 5.0 (1.3-20 years), and there was no obvious sex difference (51.1% male, 48.9% female). With respect to oral findings, 23 patients (48.9%) presented with red and/or swollen lips while only 5 (10.6%) were noted to have a strawberry tongue. Oral or oropharyngeal findings were significantly associated with the presence of systemic rash (p=0.04) and conjunctivitis (p=0.02). Conclusions The presence of oral or oropharyngeal changes may be early indicators of MIS-C and should prompt suspicion for MIS-C in the setting of COVID-19 infection.