A 7-year-old Black girl from rural Colombia was admitted with 5 days of right elbow pain, fever, asthenia, hyporexia, and coluria. She presented with contusive trauma of the aforementioned elbow 2 months before admission. She had tachycardia (144/minute), fever (38 C), tachypnea (75/minute), icterus, respiratory distress, hepatosplenomegaly, and diffuse abdominal pain. Right elbow erythema, edema, and pain were evident. The initial complete blood count test revealed thrombocytopenia (76,000/uL and 5,100/uL leukocytes), anemia (hemoglobin [Hb], 4.3 g/dl), cholestasis, and discrete elevation of the aminotransferase levels (total bilirubin, 14.63 mg/dl; direct bilirubin, 10.3 mg/dl; aspartate transaminase, 175 U/ liter; alanine aminotransferase, 128 U/liter). Because of symptomatic anemia, she received a red blood cell transfusion.Her mother reported a history of jaundice and anemia during pregnancy, without a specific diagnosis. High-flow oxygen, fluid resuscitation, empiric broad-spectrum antibiotics (vancomycin and ceftriaxone), and vasopressors were initiated. The anemic syndrome was progressive and required multiple red blood cell transfusions. Viral hepatitis (A, B, C) and