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Fatal thrombotic microangiopathy in an infant with COVID-19: a case report
Özlem Sarıtaş Nakip1, Selman Kesici1, Kıvanç Terzi1
1Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara.
Background:
While macrovascular thrombosis is common in adult COVID-19 patients, thrombotic microangiopathy as a part of endothelitis might play an important role in severe organ dysfunction. Thrombocytopenia-associated multiple organ failure (TAMOF) is a thrombotic microangiopathy syndrome that is associated with endothelial damage. Herein, we aim to report a pediatric TAMOF case related to SARS-CoV-2 infection which has been scarcely reported to date.
Case:
A 7-month-old boy who became severely ill after being infected with SARS-CoV-2 required advanced critical care treatments such as continuous renal replacement therapy, therapeutic plasma exchange, and extracorporeal membrane oxygenation. A heart and lung biopsy obtained during sternotomy showed thrombotic microangiopathy. Despite early plasma exchange, mortality was inevitable because of severe liver failure.
Conclusions:
This case report implies that SARS-CoV-2 infection could cause TAMOF in children. To the best of our knowledge, this is the second SARS-CoV-2-induced pediatric TAMOF case. More studies are needed to determine alternative treatments for patients with TAMOF who are resistant to conventional therapies.
Insights
Severe COVID-19 in a 7-month-old boy led to thrombocytopenia-associated multiple organ failure (TAMOF), a rare thrombotic microangiopathy. This case highlights the need for further research into pediatric TAMOF caused by SARS-CoV-2.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Hematology
Background:
- Thrombotic microangiopathy is implicated in severe organ dysfunction in COVID-19.
- Thrombocytopenia-associated multiple organ failure (TAMOF) is a syndrome of thrombotic microangiopathy linked to endothelial damage.
- Pediatric TAMOF cases related to SARS-CoV-2 infection are rarely reported.
Observation:
- A 7-month-old boy presented with severe illness following SARS-CoV-2 infection.
- The patient required intensive critical care, including continuous renal replacement therapy, therapeutic plasma exchange, and ECMO.
- Histopathological examination of heart and lung biopsies revealed thrombotic microangiopathy.
Findings:
- SARS-CoV-2 infection can precipitate TAMOF in pediatric patients.
- This represents one of the few documented cases of SARS-CoV-2-induced pediatric TAMOF.
- Despite aggressive treatment with plasma exchange, the patient experienced fatal liver failure.
Implications:
- This case underscores the potential for SARS-CoV-2 to cause severe thrombotic microangiopathy in children.
- Further investigation is crucial to identify effective treatments for pediatric TAMOF unresponsive to current therapies.
- Understanding the mechanisms of SARS-CoV-2-related TAMOF may improve outcomes for critically ill children.
