Tumor necrosis factor alpha (TNF-α) inhibitors are used to treat several diseases. One of the most commonly used TNF-α inhibitors in children is adalimumab. Hematologic adverse events related to this therapy (thrombocytopenia, leukopenia, anemia, or thrombotic microangiopathy) are uncommon but may lead to high morbidity and mortality. 1,2 The case we report involves an 8-year-old girl born by cesarean delivery owing to symmetrical intrauterine growth restriction, with short stature, obesity, tricuspid regurgitation, developmental delay, steatohepatitis, and a family history of psoriasis. She had suffered inverted and plaque psoriasis since age 2 years. At 7 years old, in view