Conclusion
The two cases we present are the first to demonstrate novel manifestations of COVID-19- related interaction between the liver and the immune system in pediatric patients. While activated CD8+T cell hepatitis and hepatitis-associated aplastic anemia (HAAA) are defined and well-reported on in the literature, we herein report the first association with the novel COVID-19 infection. We also report another manifestation of immune dysregulation post COVID infection that could potentially represent an atypical manifestation of MIS-C in the form of antiphospholipid (APL) syndrome leading to portal vein thrombosis.
These two pediatric cases shed light on the integral role that COVID plays in the initiation of a pro-inflammatory state that may serve as a trigger for the propagation of unregulated inflammatory cascade and immune dysregulation. It will be important to keep COVID- related activated CD8+ T-cell hepatitis in the PALF differential as well as COVID- related APL and thrombotic events, especially as pediatric case rates continue to increase. While COVID-19 infections are often reported as ‘mild’ in pediatric patients, it is important to keep rare and severe post-COVID complications in mind, both as clinicians as well as community members who are integral in promoting vaccination efforts.