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.