key: cord-0738401-wq7g7970
authors: Cant, A.; Bhujel, N.; Harrison, M.
title: Oral ulceration as presenting feature of paediatric inflammatory multisystem syndrome associated with COVID-19
date: 2020-07-03
journal: Br J Oral Maxillofac Surg
DOI: 10.1016/j.bjoms.2020.06.037
sha: e8d2d3e8d2fde48175dc000d12c658dd41bf8943
doc_id: 738401
cord_uid: wq7g7970

nan

Oral ulceration as presenting feature of paediatric Q1 inflammatory multisystem syndrome associated with COVID-19

We would like to bring attention to a recent case which was seen in the Paediatric Dentistry Department in St Thomas' Hospital, London.

The mother of a 9-year-old boy contacted our telephone triage service with concerns about oral ulceration. It was the second episode of lip swelling and ulceration in two weeks, each followed by fever, malaise and gastro-intestinal upset. Swollen lips and ulceration were followed 24 hours later by fever and the presence of altered blood in his jejunostomy drainage bag.

He had a complex medical background including severe dystonia and epilepsy.

We decided it was unwise to bring the patient in to hospital due to coronavirus concerns, so liaised with his GMP to prescribe topical hydrocortisone 2.5 mg oromucosal tablets. Telephone review 3 days later reported an improvement in lip swelling and resolving ulcers. Despite an improvement in oral symptoms, he was later admitted to paediatric intensive care with a diagnosis of paediatric multisystem inflammatory syndrome associated with COVID-19 (PIMS-TS).

We are now aware of 8 children who were admitted to the same unit with oral ulceration as an early feature of PIMS-TS Q3 (Fig. 1) .

COVID-19 usually causes a mild infection in children and is often asymptomatic. Recently, an alert was published highlighting a multi-system inflammatory syndrome sharing common features with other inflammatory conditions such as Kawasaki disease 1 . The Royal College of Paediatrics and Child Health recently published guidance on the presenting features and management of this condition 2 . Aside from the main feature of persistent fever, other symptoms include abdominal pain, cough, conjunctivitis and rash.

We believe oral ulceration to be an early feature of this condition in some children, followed by inflammatory changes elsewhere in the intestinal tract. Although the UK is now past the first spike in COVID-19 cases, and PIMS-TS is a rare complication, we feel that dentists should be vigilant of children presenting with oral ulceration, lip swelling and malaise. Other viral illnesses of childhood have similar features, so careful follow-up should be provided.

Ethics approval not required. Parental consent was gained for publication of photograph. https://doi.org/10.1016/j.bjoms.2020.06.037 0266-4356/Crown Copyright © 2020 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

Hyperinflammatory shock in children dur-Q5

Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19

We have no conflicts of interest.