Atypical Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children: A Systematic Review

Sofia Βenou, Shamez Ladhani, Gabriel Dimitriou, Despoina Gkentzi*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


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-specif-ic clinical manifestations than adults. Methods: A literature search was performed through PubMed and Scopus to summarize the extra-pulmonary manifestations of SARS-CoV-2 infection in children since the beginning of the pandem-ic. Peer-reviewed papers in English were retrieved using the following keywords and combina-tions: ‘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 patients. Results: Although fever and symptoms of upper respiratory infection are the most frequently pre-sented, a variety of other atypical presentations has also been reported. The clinical spectrum in-cludes 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.

Original languageEnglish
Pages (from-to)162-171
Number of pages10
JournalCurrent pediatric reviews
Issue number3
Publication statusPublished - Aug 2021

Bibliographical note

Publisher Copyright:
© 2021 Bentham Science Publishers.


  • Atypical manifestations
  • COVID-19
  • Children
  • Extrapulmonary manifestations
  • Pneumonia
  • SARS-CoV2


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