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Acute hepatic encephalopathy and multiorgan failure in sickle cell disease and COVID-19
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  • Giulia Martone,
  • Priyanka Nanjireddy,
  • Robin Craig,
  • Andrew Prout,
  • Meghan Higman,
  • Kara Kelly,
  • Steven Ambrusko
Giulia Martone
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Priyanka Nanjireddy
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Robin Craig
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Andrew Prout
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Meghan Higman
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Kara Kelly
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Steven Ambrusko
University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Abstract

COVID-19 disease causes primarily pulmonary manifestations, with myriad other clinical manifestations especially in high-risk conditions, including sickle cell disease (SCD). We present a 19-year-old with SCD on deferasirox with COVID-19 infection involving pain and acute chest syndrome, four weeks later developing hyperammonemia and hyperinflammatory multiorgan failure. Successful treatment included hemodialysis, red cell exchange transfusion, and therapeutic plasma exchange. Though SCD-related multiorgan failure and deferasirox-related hyperammonemia are reported, this case suggests multifactorial etiology including COVID-19-related hyperinflammation. Awareness of potential hepatic and systemic complications, and consideration for exchange transfusion and therapeutic plasma exchange, may reduce severity of COVID-19 sequelae in SCD.