Histopathological and Clinical Analysis of Skin Rashes in Children With Multisystem Inflammatory Syndrome Associated With COVID-19

• Published in: The American journal of dermatopathology Vol. 44; no. 3; pp. 183 - 189
• Main Authors: Yuksel, Selcuk, Demirkan, Nese Calli, Comut, Erdem, Yilmaz, Munevver, Gurses, Dolunay
• Format: Journal Article
• Language: English
• Published: United States The American Journal of Dermatopathology 01-03-2022
• Subjects: Adolescent; Biopsy; Child; Child, Preschool; COVID-19 - complications; COVID-19 - immunology; COVID-19 - virology; Exanthema - etiology; Exanthema - immunology; Exanthema - pathology; Female; Humans; Male; Prospective Studies; Skin - immunology; Skin - pathology; Systemic Inflammatory Response Syndrome - complications; Systemic Inflammatory Response Syndrome - immunology; Systemic Inflammatory Response Syndrome - virology
• ISSN: 0193-1091; 1533-0311
• DOI: 10.1097/DAD.0000000000002091

A new entity, which occurs a few weeks after SARS-CoV-2 infection and resembling incomplete Kawasaki disease or toxic shock syndrome, has been defined and named multisystem inflammatory syndrome (MIS-C) associated with COVID-19 in children. The aim of our study was to describe histopathological characteristics of skin lesions of MIS-C patients to reveal whether there is a relationship between histopathological features and clinical manifestations.
Seventeen who had skin involvement of 57 patients who were diagnosed with MIS-C between December 2020 and February 2021 were included in this prospective study. Demographic information, laboratory findings, and patients' managements were recorded. Skin biopsies were taken simultaneously of each patient. Formalin-fixed, paraffin-embedded skin samples were examined microscopically.
The rate of skin rash was 30% in patients with MIS-C and was predominantly the maculopapular type. The anatomical distribution of the rash was evaluated as localized in 10 and generalized in 7 patients. In patients with myocarditis, C-reactive protein and fibrinogen were found to be significantly higher, and lymphocyte and albumin values were found to be low. Herpes-like inclusions were found in the microscopic examination of 2 patients with a history of zona zoster in themselves or in their mother. There was a significant difference between keratinocyte necrosis and some clinical parameters.
Localized skin lesions appear to be associated with a more severe inflammatory.