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.