References
1. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. The New England journal of medicine.2020;383(4):334-346.
2. Letícia de Oliveira Toledo S, Sousa Nogueira L, das Graças Carvalho M, Romana Alves Rios D, de Barros Pinheiro M. COVID-19: Review and hematologic impact. Clinica chimica acta; international journal of clinical chemistry.2020;510:170-176.
3. Diorio C, McNerney KO, Lambert M, et al. Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations. Blood advances. 2020;4(23):6051-6063.
4. Consiglio CR, Cotugno N, Sardh F, et al. The Immunology of Multisystem Inflammatory Syndrome in Children with COVID-19. Cell. 2020;183(4):968-981.e967.
5. Wahlster L, Weichert-Leahey N, Trissal M, Grace RF, Sankaran VG. COVID-19 presenting with autoimmune hemolytic anemia in the setting of underlying immune dysregulation.Pediatric blood & cancer. 2020;67(9):e28382.
6. Caso F, Costa L, Ruscitti P, et al. Could Sars-coronavirus-2 trigger autoimmune and/or autoinflammatory mechanisms in genetically predisposed subjects? Autoimmunity reviews. 2020;19(5):102524.
7. Mantovani Cardoso E, Hundal J, Feterman D, Magaldi J. Concomitant new diagnosis of systemic lupus erythematosus and COVID-19 with possible antiphospholipid syndrome. Just a coincidence? A case report and review of intertwining pathophysiology.Clinical rheumatology. 2020;39(9):2811-2815.
8. Najafi S, Rajaei E, Moallemian R, Nokhostin F. The potential similarities of COVID-19 and autoimmune disease pathogenesis and therapeutic options: new insights approach.Clinical rheumatology. 2020;39(11):3223-3235.
9. Zenno A, Richardson M. Coombs Positive Thrombotic Thrombocytopenic Purpura in a Male Pediatric Patient: An Urgent Diagnostic Challenge. Pediatric blood & cancer. 2016;63(10):1860-1862.
10. Reese JA, Muthurajah DS, Kremer Hovinga JA, Vesely SK, Terrell DR, George JN. Children and adults with thrombotic thrombocytopenic purpura associated with severe, acquired Adamts13 deficiency: comparison of incidence, demographic and clinical features. Pediatric blood & cancer. 2013;60(10):1676-1682.
11. Lazarian G, Quinquenel A, Bellal M, et al. Autoimmune haemolytic anaemia associated with COVID-19 infection. British journal of haematology. 2020;190(1):29-31.
12. Fayyaz A, Igoe A, Kurien BT, et al. Haematological manifestations of lupus. Lupus science & medicine. 2015;2(1):e000078.
13. Brunner HI, Freedman M, Silverman ED. Close relationship between systemic lupus erythematosus and thrombotic thrombocytopenic purpura in childhood. Arthritis and rheumatism. 1999;42(11):2346-2355.
14. Xu S, Chen M, Weng J. COVID-19 and Kawasaki disease in children. Pharmacological research.2020;159:104951.
15. Wiernek SL, Jiang B, Gustafson GM, Dai X. Cardiac implications of thrombotic thrombocytopenic purpura.World journal of cardiology. 2018;10(12):254-266.
Figures and tables legends Figure 1 A Peripheral blood smear at presentation: Red blood cells (RBC) with numerous schistocytes and spherocytes with rare basophilic stippling and significant polychromasia. The platelets were markedly decreased in number with few large in size. White blood cells (WBC) were morphologically normal with activationFigure 1 B Peripheral blood smear following treatment: RBC with mild polychromachia and occasional schistocytes averaged 2-3 per high power field, but otherwise normal morphology. Platets and WBC are number and morphologically normal.Table 1. Summary of laboratory finding comparing presentation and following treatment