IMPORTANCE: To date, no study has characterized the mucocutaneous features seen 
in hospitalized children with multisystem inflammatory syndrome in children 
(MIS-C) or the temporal association of these findings with the onset of systemic 
symptoms.
OBJECTIVE: To describe the mucocutaneous findings seen in children with MIS-C 
during the height of the coronavirus disease 2019 (COVID-19) pandemic in New 
York City in 2020.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series was conducted of 
35 children admitted to 2 hospitals in New York City between April 1 and July 
14, 2020, who met Centers for Disease Control and Prevention and/or 
epidemiologic criteria for MIS-C.
MAIN OUTCOMES AND MEASURES: Laboratory and clinical characteristics, with 
emphasis on mucocutaneous findings, of children who met criteria for MIS-C. The 
characterization of mucocutaneous features was verified by 2 board-certified 
pediatric dermatologists.
RESULTS: Twenty-five children (11 girls [44%]; median age, 3 years [range, 
0.7-17 years]) were identified who met definitional criteria for MIS-C; an 
additional 10 children (5 girls [50%]; median age, 1.7 years [range, 0.2-15 
years]) were included as probable MIS-C cases (patients met all criteria with 
the exception of laboratory test evidence of severe acute respiratory syndrome 
coronavirus 2 [SARS-CoV-2] infection or known exposure). The results of 
polymerase chain reaction tests for SARS-CoV-2 were positive for 10 patients 
(29%), and the results of SARS-CoV-2 immunoglobulin G tests were positive for 19 
patients (54%). Of the 35 patients, 29 (83%) exhibited mucocutaneous changes, 
with conjunctival injection (n = 21), palmoplantar erythema (n = 18), lip 
hyperemia (n = 17), periorbital erythema and edema (n = 7), strawberry tongue 
(n = 8), and malar erythema (n = 6) being the most common findings. Recognition 
of mucocutaneous findings occurred a mean of 2.7 days (range, 1-7 days) after 
the onset of fever. The duration of mucocutaneous findings varied from hours to 
days (median duration, 5 days [range, 0-11 days]). Neither the presence nor 
absence of mucocutaneous findings was significantly associated with overall 
disease severity.
CONCLUSIONS AND RELEVANCE: In this case series of hospitalized children with 
suspected MIS-C during the COVID-19 pandemic, a wide spectrum of mucocutaneous 
findings was identified. Despite their protean and transient nature, these 
mucocutaneous features serve as important clues in the recognition of MIS-C.