Respiratory symptoms are the most common manifestation of COVID-19 across all age groups and it is most often associated with radiographical findings consistent with pneumonia.2 A recent systematic review estimated that 16% of children with SARS-CoV-2 infection are asymptomatic,3 or others may present with seizures, gastrointestinal bleeding or jaundice. This reports a 2-year old boy with no known co-morbidity who had a 2-week history of abdominal pain and jaundice then had a rapidly progressive course of neurological deterioration and eventual demise. He had markedly elevated liver enzymes and deranged bleeding parameters with elevated ammonia and ferritin levels. Hepatitis B and hepatitis A titers were non-reactive. He was managed as a case of hepatic encephalopathy secondary to cholestatic jaundice. His chest x-ray was normal but his SARS-CoV-2 RT PCR result was positive with a low cycle threshold. Locally, this is the first reported case of SARS-CoV-2 RT-PCR positive pediatric patient presenting as fulminant hepatic failure with no associated respiratory manifestations. Clinicians should be mindful that such presentation, however uncommon, is possible and a high index of suspicion should be maintained.
COVID-19 ; SARS-CoV-2 ; Liver Failure ; Massive Hepatic Necrosis

The clinical course of COVID-19 in the pediatric population has been reported to be mild in the majority of affected patients. However, a condition referred to as multisystem inflammatory syndrome in children (MIS-C) can occur with SARS-CoV-2 infection where patients can become critically ill. In this series, we describe five pediatric patients with the spectrum of MIS-C associated with SARS-CoV-2 infection.
COVID-19 ; SARS-CoV-2