A Case of COVID-19 Re-Infection in a Liver Transplant Patient

Coronavirus disease 2019 (COVID-19) is an ongoing worldwide pandemic infection. The exact incidence of disease re-infection or recurrence remains unknown. One particular at-risk population includes individuals with solid organ transplantation on immunosuppression. We present a case of COVID-19 re-infection in a chronically immunocompromised liver transplant patient. A 53-year-old female presented to the Emergency Department (ED) with nausea, vomiting, diarrhea, and myalgias. She was found to test positive for COVID-19. Her relevant medical history included liver transplantation on chronic immunosuppression. More recently, she had tested positive for COVID-19 approximately three months prior to this and was hospitalized at that time for encephalopathy and treated with remdesivir and convalescent plasma. She had subsequently recovered with negative COVID-19 testing in the interim. On the ED presentation with presumed re-infection, her disease was deemed to be mild with lack of severe symptoms or pulmonary involvement, and she was discharged with outpatient follow-up for monoclonal antibody infusion therapy. We describe a scenario of presumed COVID-19 re-infection in a liver transplant patient. To our knowledge, this is a rare event and has been reported internationally in only a handful of individuals. We surmise that immunosuppression could offer some protection from the inflammatory cascade of the initial disease process in COVID-19 given the relatively mild disease observed in our patient. On the other hand, a less robust immune response may decrease humoral immunity and leave patients at greater risk of re-infection. Further investigation is necessary to delineate COVID-19 disease re-infection versus relapse, especially in the setting of an immunocompromised state.