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Background  There are few reports of COVID-19 in pediatric patients with rheumatic diseases. This study describes the clinical presentation and outcomes of COVID-19 in this population.    Methods  We analyzed a single-center case series of pediatric patients with rheumatic diseases and laboratory-confirmed COVID-19. Demographic, baseline and COVID-19 associated clinical features were compared between ambulatory and hospitalized patients using univariate analysis.    Results  Fifty-five cases were identified: 45 (81.8%) in the ambulatory group and 10 (18.2%) hospitalized. African American race (OR 7.78; 95% CI [1.46–55.38];  p  = 0.006) and cardiovascular disease (OR 19.40; 95% CI 2.45–254.14;  p  = 0.001) predominated in hospitalized patients. Active rheumatic disease (OR 11.83; 95% CI 1.43–558.37;  p  = 0.01), medium/high-dose corticosteroid use (OR 14.12; 95% CI [2.31–106.04];  p  = 0.001), mycophenolate use (OR 8.84; 95% CI [1.64–63.88];  p  = 0.004), rituximab use (OR 19.40; 95% CI [2.45–254.14]; p = 0.001) and severe immunosuppression (OR 34.80; 95% CI [3.94–1704.26]; p = < 0.001) were associated with increased odds of hospitalization. Fever (OR 7.78; 95% CI [1.46–55.38];  p  = 0.006), dyspnea (OR 26.28; 95% CI [2.17–1459.25];  p  = 0.003), chest pain (OR 13.20; 95% CI [1.53–175.79];  p  = 0.007), and rash (OR 26.28; 95% CI [2.17–1459.25]; p = 0.003) were more commonly observed in hospitalized patients. Rheumatic disease flares were almost exclusive to hospitalized patients (OR 55.95; 95% CI [5.16–3023.74];  p  < 0.001).. One patient did not survive.    Conclusions  Medium/high-dose corticosteroid, mycophenolate and rituximab use, and severe immunosuppression were risk factors for hospitalization. Fever, dyspnea, chest pain, and rash were high-risk symptoms for hospitalization. Rheumatic disease activity and flare could contribute to the need for hospitalization.

Outcomes of COVID-19 in a cohort of pediatric patients with rheumatic diseases