Introduction
SARS-CoV-2 infection causing COVID-19 in sickle cell disease (SCD) is still being described. Severe COVID-19 includes a broad spectrum of illness, including excessive pro-inflammatory cytokine release with multisystem hyperinflammation, vasculitis, and coagulopathy1; many die from ARDS, thromboembolic complications, or multiorgan failure2,3,4. Although acute chest syndrome and vaso-occlusive pain crisis (VOC) in SCD patients with COVID-19 have been reported5, we present a unique case of hepatic encephalopathy, hyperammonemia, and multisystem inflammation with multiorgan failure in a SCD patient following COVID-19.