Case of “relapsing” COVID‐19 in a kidney transplant recipient

Ma, Becky Mingyao; Hung, Ivan Fan Ngai; Chan, Gary Chi Wang; Tam, Anthony Raymond; Chan, Samuel Shung Kay; Wong, Bonnie Chun Kwan; Fukuda, Kenichiro; Ohno, Takanori; Yuen, Kwok Yung; Chan, Tak Mao

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.