Immunocompromised patients may experience prolonged viral shedding after their initial SARS‐CoV‐2 infection, however, symptomatic relapses after remission currently remain rare. We herein describe a severe COVID‐19 relapse case of a kidney transplant recipient (KTR) following rituximab therapy, 3 months after a moderate COVID‐19 infection, despite viral clearance after recovery of the first episode. During the clinical relapse, the diagnosis was established on a broncho‐alveolar lavage specimen (BAL) by RT‐PCR. The infectivity of the BAL sample was confirmed on a cell culture assay. Whole genome sequencing confirmed the presence of an identical stain (Clade 20A). However, it had an acquired G142D mutation and a larger deletion of 3‐amino‐acids at position 143–145. These mutations located within the N‐terminal domain are suggested to play a role in viral entry. The diagnosis of a COVID‐19 relapse should be considered in the setting of unexplained persistent fever and/or respiratory symptoms in KTRs (especially for those after rituximab therapy), even in patients with previous negative naso‐pharyngeal SARS‐CoV‐2 PCR.
Severe relapse of SARS‐CoV‐2 infection in a kidney transplant recipient with negative nasopharyngeal SARS‐CoV‐2 RT‐PCR after rituximab