COVID-19 in a young liver transplant recipient: caution for drug-drug interactions

Immunosuppressed patients represent a vulnerable population, that may be at a higher risk for an atypical presentation and more severe courses of coronavirus disease (COVID-19). Here, we present the case of a 27-year old liver transplant recipient with a mild case of COVID-19, who was successfully treated with antivirals and hydroxychloroquine. However, the patient developed an important drug-drug interaction, with overexposure to tacrolimus and subsequent acute kidney injury, despite the discontinuation of the immunosuppressive therapy. This pragmatic case raises several concerns about the management of immunosuppression and the treatment of COVID-19 in solid organ transplant patients.