Skin Rash as Presenting Symptoms of COVID-19 in a Child

A 6-month-old male infant was admitted to our institute with a history of contact with COVID-19 positive relatives. The infant had a history of travel in a region that had registered a local surge 10 days back along with five fellow travelers from his family. The maternal uncle developed fever with myalgia after 3 days for which he tested for SARS-CoV-2 through real-time reverse transcriptase polymerase chain reaction (RT-PCR) and turned out to be positive. Therefore, upon testing of other family members because of close contact, this 6-month old infant, grandfather, and grandmother turned out to be RT-PCR COVID-19 positive. The infant's father was living in another state because of his job and was therefore, not currently staying with the patient. On admission, the infant was asymptomatic. However, on day 4 of admission, the patient developed a generalized maculopapular rash over the body, predominantly involving face and back (►Fig. 1). On the next day, the infant developed fever and diarrhea which lasted for 3 days which was managed with syrup paracetamol, zinc, and oral rehydration solution (ORS). Since the child was only experiencing mild symptoms, other laboratory investigations were not performed. The mother was tested thrice during the hospital stay and reported negative for SARS-CoV2. The infant was discharged after 7 days of an asymptomatic period.

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Fig. 1

Maculopapular rash in child with COVID-19.

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The most common presenting symptoms of COVID-19 in the pediatric population are cough and fever.¹ Skin rashes are rare in COVID-19 and only 1.8% patient from China had skin rash during COVID-19 infection.² There is lack of data on skin rash in children with COVID-19, and it has been reported recently in the context of multisystem inflammatory disease which included erythematous, maculopapular rash.³ Skin rash as presenting symptom is very rare in children and has been reported in a single case from UK to be best of our knowledge.⁴

This reports highlights the importance of clinicians being aware about the diagnosis of COVID-19 in children presenting with skin rash.