Background: In December 2019, a local outbreak of pneumonia was presented in
Wuhan (China) and quickly identified to be caused by a novel coronavirus, Severe Acute Respiratory
Syndrome Coronavirus 2 (SARS-CoV-2). The disease caused by SARS-CoV-2 was named
COVID-19 and was soon declared a pandemic because of the millions of infections and thousands
of deaths worldwide. Children infected with SARS-CoV-2 usually develop the asymptomatic or
mild type of disease compared to adults. They are also more likely to have atypical and non-specific
clinical manifestations than adults.
Methods: A literature search was performed through PubMed and Scopus to summarize the extrapulmonary
manifestations of SARS-CoV-2 infection in children since the beginning of the pandemic.
Peer-reviewed papers in English were retrieved using the following keywords and combinations:
‘pediatric,’ ‘child,’ ‘infant,’ ‘neonate,’ ‘novel coronavirus,’ ‘SARS-CoV-2,’ ‘COVID 19’
and ‘gastrointestinal,’ ‘renal,’ ‘cardiac,’ ‘dermatologic’ or ‘ophthalmologic’. We included published
case series and case reports providing clinical symptoms and signs in SARS-CoV2 pediatric
Results: Although fever and symptoms of upper respiratory infection are the most frequently presented,
a variety of other atypical presentations has also been reported. The clinical spectrum includes
dermatological, ophthalmological, neurological, cardiovascular, renal, reproductive, and gastrointestinal
presentations. In addition, a rare multi-inflammatory syndrome associated with SARS--
CoV-2 infection has been reported in children, often leading to shock and requiring inotropic support
and mechanical ventilation.
Conclusion: Clinicians need to be aware of the wider range of extrapulmonary atypical manifestations
of SARS-CoV-2 infection in children, so that appropriate testing, treatment, and public health
measures can be implemented rapidly.