Thrombotic Microangiopathy in a Severe Pediatric Case of COVID-19

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dc.authoridTaner, Sevgin/0000-0003-1578-789X
dc.contributor.authorDalkiran, Tahir
dc.contributor.authorKandur, Yasar
dc.contributor.authorKara, Emine Manolya
dc.contributor.authorDagoglu, Besra
dc.contributor.authorTaner, Sevgin
dc.contributor.authorOncu, Dogan
dc.date.accessioned2025-01-21T16:55:29Z
dc.date.available2025-01-21T16:55:29Z
dc.date.issued2021
dc.departmentKırıkkale Üniversitesi
dc.description.abstractIn this case report, we report a pediatric patient with COVID-19 and atypical hemolytic uremic syndrome (aHUS). A 3-year-old girl with fever and respiratory distress was admitted to the hospital. The patient tested positive for COVID-19 by a PCR test. As her respiratory distress increased and blood gas indicated deep respiratory acidosis on the third day of the pediatric intensive care unit follow-up, the patient was intubated and ventilated. Thorax computerized tomography (CT) showed bilateral effusion and atelectasis. During her follow-up, the pleural effusion resolved but there were marked consolidation areas and ground glass opacities compatible with COVID-19 on the follow-up CT. On the 10th day, she became anuric and developed progressive thrombocytopenia and persistent microangiopathic hemolytic anemia, which were suggestive of HUS given a high creatinine level (1.9 mg/dl), an undetectable haptoglobin level, reticulocytosis (8%), and an LDH level of 2540 U/l. Direct Coombs test returned negative. Examination of a peripheral blood smear revealed schistocytes. Disseminated intravascular coagulation was ruled out by normal INR and PTT. In the light of the available findings, we considered the patient to have thrombotic microangiopathy (TMA) triggered by COVID-19. It was not a TTP-form of TMA but rather an aHUS type, based on an ADAMTS13 activity level >5%. Hence, plasmapheresis was performed with fresh frozen plasma (FFP). After 4 weeks, she became completely asymptomatic, and her hemodynamic parameters normalized. COVID-19 induced uncontrolled complement activation leading to the development of aHUS. Early diagnosis and treatment may reduce morbidity and mortality since its treatment options.
dc.identifier.doi10.1177/11795565211049897
dc.identifier.issn1179-5565
dc.identifier.pmid34707424
dc.identifier.urihttps://doi.org/10.1177/11795565211049897
dc.identifier.urihttps://hdl.handle.net/20.500.12587/25791
dc.identifier.volume15
dc.identifier.wosWOS:000710772200001
dc.identifier.wosqualityN/A
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSage Publications Ltd
dc.relation.ispartofClinical Medicine Insights-Pediatrics
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_20241229
dc.subjectCOVID-19; pediatric patient; hemolytic uremic syndrome
dc.titleThrombotic Microangiopathy in a Severe Pediatric Case of COVID-19
dc.typeArticle

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