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Pitfalls of Thrombotic Microangiopathies in Children: Two Case Reports and Literature Review
Adriana Mocanu1,2, Roxana Alexandra Bogos1,2, Tudor Ilie Lazaruc1
1Mother and Child Medicine Department, Discipline of Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Street, 700115 Iasi, Romania.
Insights
Pediatric thrombotic microangiopathies like thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) present diagnostic challenges. COVID-19 may trigger these rare conditions, necessitating prompt diagnosis and intervention.
Area of Science:
- Pediatric Hematology
- Critical Care Medicine
- Infectious Diseases
Background:
- Thrombotic microangiopathies (TM) encompass diverse clinical entities posing diagnostic and therapeutic challenges in pediatric practice.
- Thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) are rare TM subtypes with overlapping clinical and biological features, complicating differential diagnosis.
- The potential role of COVID-19 infection as a trigger for TTP and aHUS in children is an emerging concern.
Purpose of the Study:
- To explore the clinical evolution of two rare pediatric cases of TTP and aHUS with similar presentations.
- To review the literature on COVID-19 associated TTP and aHUS in pediatric populations.
- To highlight the diagnostic complexities and therapeutic implications of TM in children.
Main Methods:
- Case report analysis of two pediatric patients with TTP and aHUS.
- Comprehensive literature review of COVID-19 associated TTP and aHUS in children.
- Comparative analysis of clinical and biological findings.
Main Results:
- The study presents two pediatric cases of TTP and aHUS with nearly identical clinical pictures, underscoring diagnostic difficulties.
- Literature research identified 15 pediatric cases of COVID-19 associated with TTP or aHUS.
- The findings suggest a potential link between COVID-19 infection and the development of TTP and aHUS in children.
Conclusions:
- TTP and aHUS represent significant diagnostic challenges in pediatric patients due to overlapping manifestations.
- COVID-19 infection should be considered a potential trigger for TTP and aHUS in pediatric cases.
- Prompt and accurate differential diagnosis is crucial for effective management and improved outcomes in pediatric TM.
Abstract:
Thrombotic microangiopathy can present itself in the form of several clinical entities, representing a real challenge for diagnosis and treatment in pediatric practice. Our article aims to explore the evolution of two rare cases of pediatric thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS) with extremely similar clinical pictures, which, coincidentally, presented at approximately the same time in our hospital. These cases and our literature review demonstrate the multiple facets of thrombotic microangiopathy, which can produce various determinations and salient manifestations even among the pediatric population. TTP and aHUS may represent genuine diagnostic pitfalls through the overlap of their clinical and biological findings, although they develop through fundamentally different mechanisms that require different therapeutic approaches. As a novelty, we underline that COVID-19 infection cannot be excluded as potential trigger for TTP and aHUS in our patients and we predict that other reports of such an association will follow, raising a complex question of COVID-19's implication in the occurrence and evolution of thrombotic microangiopathies. On this matter, we conducted literature research that resulted in 15 cases of COVID-19 pediatric infections associated with either TTP or aHUS. Taking into consideration the morbidity associated with TTP and aHUS, an elaborate differential diagnosis and prompt intervention are of the essence.
