Case of 'relapsing' COVID ‐19 in a kidney transplant recipient

Clinical outcomes of COVID‐19 vary considerably between patients. Little was known about the clinical course and optimal management of immunosuppressed patients infected with SARS‐CoV‐2. We report a kidney transplant recipient with COVID‐19 who presented with pneumonitis and acute kidney injury (AKI). She improved after reduction of immunosuppressive treatment and had two consecutive negative reverse transcription polymerase chain reaction (RT‐PCR) tests. Her respiratory tract samples turned positive again afterwards, and she was treated with lopinavir‐ritonavir. She had satisfactory virological and clinical response after a prolonged disease course. This case illustrates the risk of relapse or persisting shedding of SARS‐CoV‐2 in immunosuppressed patients, the important role of viral load monitoring in management, the challenges in balancing the risks of COVID‐19 progression and transplant rejection, and the pharmacokinetic interaction between immunosuppressive and antiviral medications.
SUMMARY AT A GLANCE A kidney transplant recipient with COVID‐19, who had a prolonged, apparently relapsing course of SARS‐CoV‐2 infection is described. This case illustrates the need for vigilance during recovery from COVID‐19 in transplant recipients, and some of the challenges with managing immunosuppression and using novel unapproved anti‐viral therapies.