Toddler With New Onset Diabetes and Atypical Hemolytic Uremi
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COVID-19 is also associated with a pro-thrombotic state with increased risk of thrombosis and disseminated intravascular coagulation (DIC). While other viruses, such as H1N1 Influenza, have been associated with thrombotic microangiopathies (TMAs) and infection can be a relapse trigger in patients with TMA due to atypical hemolytic uremic syndrome (aHUS), there has not yet been definitive evidence linking COVID-19 with TMAs.

Autopsy of patients with COVID-19 revealed that 3 out of 21 patients had generalized TMAs. There is growing speculation that TMAs play a large role in COVID-19. This case describes a toddler who presented with COVID-19, DKA and aHUS treated with eculizumab. This is the first COVID-19 presentation of its kind.

This is a novel case of a 16-month-old male with a history of prematurity with intrauterine growth restriction, severe failure to thrive, microcephaly, pachygyria, agenesis of the corpus callosum and postnatal embolic stroke, who presented with new-onset diabetes mellitus with diabetic ketoacidosis in the setting of SARS-CoV-2 infection, with a course complicated by atypical hemolytic syndrome (aHUS). This patient demonstrated remarkable insulin resistance in the period prior to aHUS diagnosis which resolved with the first dose of eculizumab therapy.

There is increasing evidence that COVID-19 is associated with thrombotic disorders and that microangiopathic processes and complement-mediated inflammation may be implicated. This case report describes a pediatric patient with COVID-19 and a new complement-mediated microangiopathic thrombotic disease. As whole exome sequencing and extensive workup returned without a clear etiology for aHUS, this is likely a COVID-19 triggered case of aHUS versus an idiopathic case that was unmasked by the infection.