Introduction
In addition to the classic features of COVID-19, children may present with multisystem inflammatory syndrome in children (MIS-C) with prolonged fever, shock, mucocutaneous symptoms and cardiac dysfunction.1 In adults, acute COVID-19 has been shown to be associated with hematological complications such as thrombotic thrombocytopenic purpura (TTP), autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). 2 We present a pediatric patient with features suggestive of MIS-C with coronary artery ectasia, AIHA and TTP. He also had immunological features consistent with new onset Systemic lupus erythematosus (SLE) and presence of antiphospholipid antibodies. Although thrombotic microangiopathy (TMA) due to complement activation has been reported in some children with COVID-19 across a spectrum of clinical manifestations,3 our patient had unusual presentation of TTP which has hitherto not been described. As data on COVID-19 continues to evolve in children, our case adds to the body of literature defining the multitude of manifestations of this challenging disease.