The present report describes the case of a 31-year-old primigravida, with dichorionic twins at 31 weeks . She presented with history of myalgia, jaundice, and abdominal discomfort . No flu-like symptoms as fever or cough . She was not aware of exposure to COVID-19 . Normal blood pressure and O2 saturation . Laboratory tests showed platelet count of 218,000 mm3, alanine aminotransferase (ALT) 558 IU and serum creatinine 2.3 mg/dl . Doppler ultrasound in one twin was compatible with brain sparing . Partial hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome was the hypothesis, and a cesarean section was performed . On day 2, the white-cell count reached 33,730, with decreased consciousness and mild respiratory distress . Tomography revealed both lungs with ground-glass opacities . Swab for COVID-19 polymerase chain reaction (PCR) was positive . Thrombocytopenia in patients with COVID-19 appears to be multifactorial, similar to what occurs in preeclampsia and HELLP syndrome . We assume that the synergism of these pathophysiological mechanisms could accelerate the compromise of maternal conditions and could be a warning to the obstetric practice.