Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2020; 26(44): 7076-7084
Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.7076
COVID-19 in a liver transplant recipient: Could iatrogenic immunosuppression have prevented severe pneumonia? A case report
Anna Sessa, Alessandra Mazzola, Chetana Lim, Mohammed Atif, Juliana Pappatella, Valerie Pourcher, Olivier Scatton, Filomena Conti
Anna Sessa, Department of Hepatology and Gastroenterology, University of Naples Federico II, Napoli 80131, Italy
Anna Sessa, Alessandra Mazzola, Juliana Pappatella, Filomena Conti, APHP, Unité Médicale de Transplantation Hépatique Hôpital Pitié Salpêtrière, Paris 75013, France
Alessandra Mazzola, Olivier Scatton, Filomena Conti, Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris 75013, France
Chetana Lim, Olivier Scatton, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation Hépatique, Hôpital Pitié Salpêtrière, Paris 75013, France
Mohammed Atif, APHP, Centre d’immunologie et des Maladies Infectieuses, Inserm U1135, Hôpital Pitié-Salpêtrière, Paris 75013, France
Juliana Pappatella, Hospital Felicio Rocho, Barro Preto 9530, Brazil
Valerie Pourcher, APHP, Service des Maladies Infectieuses, Hôpital Pitié Salpêtrière, Paris 75013, France
Filomena Conti, Sorbonne Université, INSERM, Institute of Cardiometabolisme and Nutrition (ICAN), Paris 75013, France
Author contributions: Sessa A and Mazzola A were the patient’s doctors, reviewed the literature and contributed to manuscript drafting; Pourcher V performed the infectious diseases consultation, and drafted the manuscript; Lim C performed the surgery consultation; Pappatella J contributed to manuscript drafting; Scatton O, Conti F and Atif M were responsible for the revision of the manuscript for important intellectual content; and all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Alessandra Mazzola, MD, PhD, Doctor, APHP, Unité Médicale de Transplantation Hépatique Hôpital Pitié Salpêtrière, Boulevard de l’Hôpital 47-83, Paris 75013, France.
Received: May 5, 2020
Peer-review started: May 5, 2020
First decision: May 15, 2020
Revised: May 22, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: November 28, 2020

Coronavirus disease (COVID) is a new and highly contagious infectious disease caused by the coronavirus (COVID-19 or severe acute respiratory syndrome coronavirus 2). There is limited data regarding the incidence and management of COVID-19 in immunocompromised patients’ post-transplantation. In the pre-COVID-19 era, these patients were already at an increased risk of developing opportunistic infections. These often manifested with atypical symptoms.


We report another case of uneventful COVID-19 pneumonia in a 58-year old male who was 18 mo’ post liver transplantation. He received tacrolimus monotherapy since July 2019. The clinical manifestations included only epigastric pain radiating to the right hypochondrium, nausea and vomiting. He had no fevers, cough, shortness of breath, anosmia or dysgeusia even if the chest computed tomography scan revealed an extension of the multiple patchy ground-glass density shadows to the upper lobe of the left lung too. He was hospitalised and received a course of oral chloroquine (200 mg × 3 per day) for a period of 10 d. Interestingly, the COVID 19 infection was uneventful though there were no modifications to his tacrolimus dosing. He was successfully discharged. We performed subsequent follow-up via telemedicine.


In light of the current pandemic, it is even more important to identify how the liver recipient’s patients present and are managed, especially for immunosuppression treatment.

Keywords: Liver transplantation, COVID-19, Immunosuppression, Gastrointestinal symptom, Infection, Case report

Core Tip: Coronavirus disease (COVID) is a novel and unknown infectious disease that involves all the world due to a novel coronavirus (named severe acute respiratory syndrome coronavirus 2 latter). Immunocompromised patients often present atypical presentations of viral diseases. We report a case of a COVID-19 infection in a liver transplant recipient, in which the first clinical symptoms were abdominal pain without fever or respiratory symptoms. The immunosuppression seems to be doesn’t worsen the prognostic of COVID-19 pneumonia for this patient but future studies including more patients are needed to explore the impact of COVID-19 infections in this special setting.