He was diagnosed with RIME associated with COVID-19. Microbiology investigations were negative for herpes simplex virus, mycoplasma and human herpesvirus 6. Inflammatory markers were mildly elevated (C-reactive protein 65.6mg/L, lactate dehydrogenase 326 U/L, ferritin 89.8µg/L and D-dimer 0.67mg/L). Results of SARS-CoV-2 polymerase chain reaction (PCR) and SARS-CoV-2 serology tests were positive. Examination by the ophthalmologist showed no keratoconjunctivitis. Coalescing ulcers were noted over the buccal mucosa, posterior pharynx and tongue. Clinically, there were extensive erosions with crusting over the upper and lower lips, with blister formation (Fig. There was almost full recovery of his digital lesions after another 2 weeks.Ĭase 2 was a previously well 10-year-old Indian boy who presented with 3 days of lower lip swelling and lip ulcers associated with mild cough and sore throat, which were complicated by poor feeding. He was diagnosed to have COVID-19-related chilblains, and discharged after 4 days. Blisters on his digital lesions were treated and topical cream (fusidic acid and betamethasone) was applied. However, there was no clinical improvement so referral to the dermatology team was made. He was commenced on intravenous cefazolin. He was reviewed by the orthopaedic surgeon for initial concerns of felon progressing to septic arthritis or osteomyelitis. There were multiple shallow ulcers and erosions with violaceous plaques on his finger pulps (Fig. The main objective is to describe the clinical characteristics of these patients, focusing on chilblains-like acute acral eruptions (AAE), and reactive infectious mucocutaneous eruption (RIME), with relevance to COVID-19 infection.Ĭase 1 was a 6-year-old Malay boy who presented acutely with painful skin lesions on his fingers with respiratory symptoms and fever. 1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore. Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.
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