DISCUSSION
By presenting this case we aim to raise awareness that ITP may be
triggered by SARS-COV-2 infection especially in very young children who
present with mild or no symptoms during the time of acute viral illness.
The pathogenesis of ITP secondary to COVID-19 may be attributed to
various mechanisms [5,6]. Potential pathogenetic pathways causing
thrombocytopenia in COVID-19 patients include molecular mimicry, direct
viral infection, and inhibition of the platelet synthesis, underlying
immune dysregulation, susceptibility mutations in SOCS-1 gene and others
[1]. In the case of pathogen-specific induced ITP, the host
cross-reacting with glycoproteins on the platelet membrane produces
antiviral antibodies, leading to destruction of the platelet membrane,
early, accelerated platelet consumption and clinically overt
thrombocytopenia [6]. In any case as the spectrum of diseases and
complications associated with the novel SARS-COV-2 infection are still
under the radar, further immunological and genetic investigations are
required to verify the causative association between SARS-COV-2.
Only a handful of cases described in the current literature report the
presence of pediatric ITP associated with a previous COVID-19 infection;
the children were above 10 years old in all cases [1.2] This is an
original report of ITP post COVID-19 infection in a two-year old patient
leading to severe thrombocytopenia. Therefore, since ITP cases have been
reported in asymptomatic COVID-19 patients, we suggest testing for
SARS-CoV-2-specific-antibodies should be routinely performed in all
newly diagnosed patients with ITP irrespective of COVID-19 symptoms
[4] in view of the current pandemic.