The Turkish Journal of Pediatrics 2023 , Vol 65 , Num 4
Fatal thrombotic microangiopathy in an infant with COVID-19: a case report
Özlem Sarıtaş Nakip 1 ,Selman Kesici 1 ,Kıvanç Terzi 1 ,Diclehan Orhan 2 ,Benan Bayrakcı 1
1 Department of Pediatric Critical Care Medicine, Life Support Center, Hacettepe University Faculty of Medicine, Ankara
2 Department of Pediatric Pathology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
DOI : 10.24953/turkjped.2022.1150 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. Keywords : COVID-19, TAMOF, thrombotic microangiopathy, therapeutic plasma exchange

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