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.