Thrombotic thrombocytopenic purpura associated with COVID-19 in a critically ill child: A Peruvian case report

Abstract

Background Acquired thrombotic thrombocytopenic purpura (TTP) is a rare disease. This pathology requires necessary resources for its diagnosis, especially in the context of the pandemic by the new SARS-CoV-2 coronavirus due to the lack of diagnostic tests and the variable response to plasma exchange in middle and low-income countries. Case report: We report a case of a 9-year-old Hispanic boy with SARS-CoV-2 (IgG) infection, with atypical presentation and multisystemic involvement, thrombotic microangiopathy, dermal manifestations, hematologic, kidney, and neurologic involvement. Post SARS-CoV-2 infection evolution, application of the PLASMIC score, and genetic study were performed. Ventilatory and hemodynamic support, corticotherapy, immunoglobulins, plasma exchange, renal replacement therapy, and monoclonal antibodies were given without favorable response. Conclusions TTP associated with SARS-CoV-2 is infrequent in the pediatric population. Necessary resources are needed to make the diagnosis and maintain the necessary support and management to avoid fatal outcomes.