Prolonged shedding of SARS-CoV-2 in an elderly liver transplant patient infected by COVID-19: a case report

Coronavirus disease 2019 (COVID-19) pandemic gripped the globe. SARS-CoV-2 is highly infectious and is susceptible to all populations. Immunosuppressed patients have greater risk for opportunistic infections. However, the understanding regarding the biological characteristics of SARS-CoV-2 in immunosuppressed patients remains unclear. Herein, we present a case of prolonged shedding of SARS-CoV-2 in a liver transplant patient with COVID-19. A 61-year-old male post liver transplant was confirmed COVID-19 infection on day 10 of illness onset. The patient has received immunosuppressive treatment for over 11 years and has a history of hypertension for 10 years. With antiviral treatment and temporary discontinuation of tacrolimus immunosuppression, he had complete clinical symptoms relieve on day 24. However, recurrently positive tests of SARS-CoV-2 RNA were presented on day 35 and on day 39 after two consecutive negative tests. IgG antibody test for SARS-CoV-2 was positive with IgM negative on day 41. The final shedding duration lasted 52 days. Prolonged shedding of SARS-CoV-2 should be a matter of concern and might attribute to long-term immunosuppression. Therefore, dynamic surveillance and prolonged quarantine are required for immunocompromised individuals. Further data should be collected to investigate if there is a universal prolonged shedding window of SARS-CoV-2 in immunosuppressed patients.