Successful Treatment of COVID-19 and Multisystem Inflammatory Syndrome in Children Associated Severe Aplastic Anemia With Unrelated Donor Stem Cell Transplantation

Abstract

Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 has many known complications affecting different organ systems, including the hemopoietic system. Previous reports showed that children with severe aplastic anemia (SAA) secondary to MIS-C had different outcomes, some with spontaneous recovery of blood counts and others with refractory SAA. Another case described a young adult with paroxysmal nocturnal hemoglobinuria (PNH) who had refractory aplastic anemia from COVID-19. We describe an unusual case of SAA in a teenager with MIS-C who did not have spontaneous recovery of his blood cell counts, and he was ultimately treated with matched unrelated donor stem cell transplant. Next generation sequencing of bone marrow revealed a variant of unknown significance in the phosphatidylinositol glycan class A (PIG-A) gene. While further studies are needed, we hypothesize that this patient had subclinical PNH that was exacerbated by the acute COVID-19 infection and MIS-C. Stem cell transplantation can lead to successful outcome in this scenario.