Introduction:
Hereditary spherocytosis (HS) is an inherited hemolytic disease which has a wide spectrum of phenotypic expression ranging from asymptomatic to chronic ongoing hemolysis1. Clinical findings of this disease are due to genetic mutations in plasma membrane proteins which result in an unstable red blood cell membrane-cytoskeleton interaction. This dysfunctional interaction places the red blood cells at higher risk for hemolysis triggered by various stressors including fever and hypoxia.1-3 Splenic clearance of damaged red blood cells results in anemia , thus patients are treated with supportive transfusion and splenectomy can be utilized to decrease chronic hemolysis in severely affected patients.4,5
The novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in Wuhan province in China in December 2019 and has affected over 2 million people globally as of April 2020.6 Many studies have found that the spread of COVID-19 is very rapid due to the highly contagious nature of the disease, resulting in a global pandemic.7-10 While information about this virus is still evolving, children have had less severe manifestations of COVID-19 with proportionately fewer pediatric cases requiring hospitalization.11 In the US, a Center for Disease Control Morbidity and Mortality Weekly Report found that children account for 22% of the population but only 1.7% of overall COVID-19 cases.12 There is still much to learn regarding how COVID-19 affects children with underlying chronic disorders and what important clinical presentations and labs should be followed in patients who have a chronic illness.
We describe a unique case of a pediatric patient infected with COVID-19 in the setting of a known chronic illness, HS, and the resulting presentation and medical complications. This case report is published with parental permission.