Fatal thrombotic microangiopathy in an infant with COVID-19: a case report


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Nakip Ö. S., KESİCİ S., TERZİ K., ORHAN D., BAYRAKCİ B.

The Turkish journal of pediatrics, cilt.65, sa.4, ss.667-671, 2023 (Scopus) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 65 Sayı: 4
  • Basım Tarihi: 2023
  • Doi Numarası: 10.24953/turkjped.2022.1150
  • Dergi Adı: The Turkish journal of pediatrics
  • Derginin Tarandığı İndeksler: Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.667-671
  • Anahtar Kelimeler: COVID-19, TAMOF, therapeutic plasma exchange, thrombotic microangiopathy
  • Hacettepe Üniversitesi Adresli: Evet

Özet

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.