Bone marrow suppression, a rare presentation of Sars-CoV-2 infection in a child living in a low-income country: A case report with literature review

Background: COVID -19 is a clinical condition caused by the Coronavirus SARS-CoV-2. It was a global pandemic which affected both adults and children during its outbreak in 2019. Bone marrow suppression is an uncommon but significant complication observed in paediatric patients which can worsen morbidity and mortality. Furthermore, given the fact that the marrow suppression may mimic other diseases such as leukaemia, a high index of suspicion is imperative for prompt diagnosis and treatment. Case Presentation: We describe the diagnostic evaluation and management of a 5-year-old female with bone marrow suppression as a complication of SARS-CoV-2 infection. She presented with fever and paleness of the body. Initial examination showed severe pallor with tachycardia and tachypnoea. Investigations revealed pancytopenia with reticulocyte count at lower limit of normal. Peripheral blood film showed reduction of all three cell lines. Bone marrow aspiration showed a hypocellular marrow for the age of the child. Immunoglobulin M (IgM) for COVID-19 was found to be positive. Patient’s clinical condition has markedly improved as haematologic parameters have returned to near normal and has not needed any transfusion for about 1 year. The diagnosis of bone marrow suppression following SARS-CoV-2 infection requires a good history, physical examination, high index of suspicion and extensive investigations. Management entails recurrent transfusions, corticosteroids and supportive treatment.