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The present COVID-19 pandemic is a cause for concern among solid-organ transplant recipients, who are generally at high risk for infection and for whom infection with COVID-19 carries additional risks for complications and mortality that are higher than the COVID-19-associated risks for the general population. We report the case of a liver transplant recipient who presented with COVID-19 and multiple complications. A 39-year-old woman with a liver transplant was diagnosed with COVID-19 within the first week after transplant surgery. Mycophenolate was withheld, and interferon β was administered for management of COVID-19. She developed thrombotic thrombocytopenic purpura, acute antibody-mediated rejection, and posterior reversible leukoencephalopathy syndrome during hospitalization. All of these complications may be related to COVID-19 or its management modalities. We considered 3 possible causes for thrombotic thrombocytopenic purpura in this patient: the COVID-19 infection itself, immunosuppression treatment with cyclosporine, and treatment with interferon β. Immunosuppression reduction and interferon treatment may result in antibody-mediated rejection. COVID-19, thrombotic thrombocytopenic purpura, and cyclosporine may play a combined role in the development of posterior reversible leukoencephalopathy syndrome. In conclusion, thrombotic thrombocytopenic purpura, antibody-mediated rejection, and posterior reversible leukoencephalopathy syndrome may represent a continuum of 3 thrombotic microangiopathy conditions fostered by interplay between the COVID-19 infection and the treatment modalities for COVID-19 management in this patient.

Background: Toxoplasmosis is a common parasitic disease, which leads to serious disease symptoms in immunocompromised hosts and infants. Recent epidemiologic surveys showed that microbial agents may be associated with some cases of multiple sclerosis (MS). Objectives: This case-control study aimed to examine the role of Toxoplasma gondii in MS by evaluating sero-frequency of anti-T. gondii IgG (ATXAb) antibody between patients with MS and ordinary people in Shiraz Province, south of Iran during 2016 - 2018. Methods: Serum samples obtained from MS patients (n = 130), and a group of age and gender-matched controls (n = 130) with the same socioeconomic status with the patients’ group were collected to evaluate the prevalence of T. gondii IgG antibodies (ATXAb). Moreover, the presence of the ATXAb antibody of the patients and controls was determined by the ELISA test. SPSS 20 software was used to perform the statistical analysis (SPSS, inc., Chicago, USA). Results: Out of 130 (35.4%) cases with MS and 130 (13.8%) controls, 46 and 18 subjects were seropositive for ATXAb, respectively. Based on the chi-square test, a significant difference was observed in terms of the positivity rates of ATXAb between the MS patient group and the control group (P = 0.001). The mean ± standard deviation ATXAb levels in controls and MS patients were found to be 61 ± 34 and 114 ± 47 IU/mL, respectively. Also, there were statistically significant differences between the levels of these two groups (P = 0.001). Conclusions: Given the relationship between toxoplasmosis and MS, it is possible that the prevalence of MS decreases by increasing hygiene and preventing toxoplasmosis.