Extrapulmonary manifestations of COVID-19 in children: a comprehensive review and pathophysiological considerations

Objective: The aim of this review was to summarize the most common extrapulmonary manifestations in pediatric patients with COVID-19, as well as to discuss clinical, epidemiological, and pathophysiological aspects of these clinical presentations in children. Source of data: An extensive search of literature was performed in order to identify pediatric cases with extrapulmonary manifestations between January 1, 2020 and June 21, 2020. Generic keywords, such as ''Novel coronavirus or Novel coronavirus 2019 or 2019 nCoV or COVID-19 or SARS-CoV-2 were searched on PubMed database, associated either with age filters or generic pediatric terms. Summary of findings: A total of 28 articles, including 199 patients, were considered suitable to review and data extraction. The main findings were summarized in tables. The main non -pulmonary manifestations in pediatric patients, in decreasing order of frequency, were gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, cutaneous, hepatic, ocular, olfactory, and gustatory. Multisystem impairment and Kawasaki -like disease were also described. Conclusions: Differences in immune response of children and variations of tissue expression of angiotensin converting enzyme 2, the virus receptor, are likely to influence clinical, epidemiological, and pathophysiological patterns of the disease. (C) 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.

Automated summary

This review summarizes the most common extrapulmonary manifestations in pediatric patients with COVID-19, including gastrointestinal, renal, cardiovascular, neurological, hematological and lymphatic, and cutaneous presentations. Multiple systemic impairments and Kawasaki-like disease were also reported. Understanding these clinical presentations can provide insights into the clinical, epidemiological, and pathophysiological patterns of the disease in children.