Thrombotic microangiopathy with multiorgan involvement following COVID-19

Acute kidney injury is common among hospitalized COVID-19 patients, with the incidence ranging from 0.5% to 80%, due to diverse pathologies including acute tubular injury, collapsing glomerulopathy, and thrombotic microangiopathy (TMA). While macrovascular thrombosis is common in these individuals, the frequent finding of extensive microvascular thromboses in several series and case reports raises the possibility of thrombotic microangiopathy (TMA) being a contributing factor in the thrombotic and multiorgan complications of the disease. TMA has been described as either the primary finding or in concert with other pathologic findings in COVID-19 patients and carries a poor prognosis, with all patients requiring dialysis. We present a case of TMA with retinal injury and bowel perforation in addition to pulmonary and renal manifestations.