Venous Thromboembolic Disease in Children Associated with COVID-19

Venous thromboembolism (VTE) in children is rare and VTE in association with antiphospholipid antibodies (lupus anticoagulant, cardiolipin antibodies and beta-2 glycoprotein I) is even rarer. The development of these antibodies can be due to an acute infection or an autoimmune disease. Recently, these antibodies have been noted to be present in conjunction with SARS-CoV-2 in adult patients with VTE.We report 5 cases of VTE associated with presence of antiphospholipid antibodies in children over a short period during the coronavirus 19 pandemic. One child had SARS-CoV-2 PCR positive on nasopharyngeal swab while 2 had positive antibodies (IgM) to SARS-CoV-2. One adolescent female had features of Multi-Inflammatory System in Children (MIS-C) a few weeks before presenting with multiple pulmonary emboli and DVT. Thrombotic events included DVT of lower extremity (3 patients), multiple PE (2 patients), orbital vein thrombosis (1 patient) and upper extremity DVT (1 patient). Two of these patients had both DVT and PE. All patients had one or more antiphospholipid antibody present. Two adolescent females had new onset of systemic lupus erythematous. All patients were treated with systemic anticoagulation with heparin (initially with unfractionated heparin if clinically unstable and later changed to low molecular weight heparin).We report a cluster of adolescents with unusual thrombotic complications with antiphospholipid antibody positivity during the coronavirus 19 pandemic, 3 with positive virologic criteria, one with delayed presentation after MIS-C like features and one with close family member exposure. We hypothesize that VTE in children is likely due to development of antiphospholipid antibodies when associated with SARS-CoV-2 infection.