Unusual suspect in a common diagnosis: think beyond ‘minimal’

Nephrotic syndrome is a glomerular disease commonly seen in paediatric population. The disease is characterized by a hypercoagulable state and risk of thromboembolic complications. Cerebral venous thrombosis (CVT) is a rare complication in children associated with nephrotic syndrome with an incidence of 0.67/100000 with very few case reports described. 12-year-old girl with steroid dependent nephrotic syndrome- minimal change disease, with a background of recent COVID-19 infection, presented with vomiting, headache, altered sensorium and an episode of generalized tonic clonic seizure. Diagnosis established by magnetic resonance imaging (MRI) brain and MR venogram which showed superior sagittal sinus thrombosis. Child was started on anticoagulant therapy, gradually recovered with no neurological sequelae. Thrombosis should be suspected in nephrotic syndrome with the added risk of hypercoagulable state associated with COVID-19 infection. Cortical vein thrombosis, even though rare, should be considered in any patient with nephrotic syndrome who presents with neurological signs or symptoms, especially in this era of COVID-19 pandemic. This highlights the importance of suspecting and recognizing post COVID hypercoagulability as a triggering factor for neurological complications associated with the same. Thromboembolic events are rare in paediatric patients with COVID-19 infection, but a high index of suspicion should be maintained in children, particularly those with comorbidities.