Multisystemic Inflammatory Syndrome and Thrombotic Microangiopathy as Complications of COVID-19 in a Child: A Case Report

Abstract

Clinical presentations of the novel coronavirus (SARS-CoV-2) infection are quite varied, ranging from asymptomatic conditions to potentially fatal disease. The kidney is one of the affected targets of coronavirus disease (COVID-19) complications, and renal dysfunction is a significant prognostic factor for mortality. This report describes a series of clinical complications in a previously healthy child who developed nephritic syndrome with a concomitant SARS-CoV-2 infection. These complications include acute kidney injury that progressed to chronicity, multisystemic inflammatory syndrome, Kawasaki-like syndrome, and thrombotic microangiopathy.

Severe Thrombocytopenic Purpura Associated with COVID-19 in a Pediatric Patient

“… 30 Because our patient presented normal lactate dehydrogenase (LDH) levels upon admission and hospital stay, normal RBC morphology on blood smear, normal hemoglobin levels for age group (11.3–13.7 g/dL), normal blood pressure, she did not meet the criteria for TMA despite having renal dysfunction and alanine aminotransferase or aspartate aminotransferase levels >3 times the upper limit of normal. 13 , 30 , 44 The etiology of acute kidney disease (AKI) in SARS-CoV-2 infection is diverse and multifactorial. 44 A review by Chen et al, proposed several mechanisms to justify the renal involvement in COVID-19 patients, including multiple organ dysfunction syndrome, direct renal infection by SARS-CoV-2, AKI after acute respiratory distress syndrome, and cytokine storm syndrome.…”

“… 13 , 30 , 44 The etiology of acute kidney disease (AKI) in SARS-CoV-2 infection is diverse and multifactorial. 44 A review by Chen et al, proposed several mechanisms to justify the renal involvement in COVID-19 patients, including multiple organ dysfunction syndrome, direct renal infection by SARS-CoV-2, AKI after acute respiratory distress syndrome, and cytokine storm syndrome. 45 In a retrospective study on 89 pediatric patients, by Kari et al, AKI occurred in one-fifth of children with SARS-CoV-2 infection requiring hospital admission, with one-third of those requiring pediatric ICU.…”

COVID‐19 associated thrombotic microangiopathy

“…A limited number of paediatric cases of TMA have been reported during COVID‐19, of which only two were treated with eculizumab 8–13 . Our report also describes two children with TMA with no known aetiology other than confirmed COVID‐19, one of whom was treated with eculizumab.…”

Commentary: Hematuria as an early sign of multisystem inflammatory syndrome in children: A case report of a boy with multiple comorbidities and a review of the literature

“…In reported cases, it was only associated with severe acute kidney injury (AKI) or other underlying conditions (thrombotic microangiopathy (TMA), renal infarcts). No authors report spontaneous remission without treatment, which contradicts the case presented and the relevant articles (16)(17)(18)(19)(20). The article indirectly suggests that the hematuria was of short duration.…”

“… Some aspects of the case report suggest a possible underlying nephrological disease as comorbidity. It is known that acute Sars-Cov-2 infection may trigger an underlying disease to manifest clinically ( 17 , 21 ). IgA nephropathy manifests with periodic macrohematuria with spontaneous remission.…”