Background: Immunocompromised persons may be at higher risk for recrudescent infections and reinfections with SARS-CoV-2. However, the 2 entities can be difficult to distinguish, and cases have been infrequently documented.
Objective: To distinguish SARS-CoV-2 reinfection from recrudescence in a liver transplant recipient with 2 distinct episodes of COVID-19 using clinical history and viral genomic sequencing.
Case Report: The patient is a 61-year-old man who has a history of liver transplant due to chronic hepatitis B and C virus infections and is receiving maintenance immunosuppression with tacrolimus and mycophenolate mofetil. He presented to the emergency department (ED) with fever, nausea, vomiting, and cough. He was stable in the ED and was discharged home, and symptoms resolved within 12 days. We detected SARS-CoV-2 by reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) on a nasopharyngeal swab collected during his ED visit. Results were negative on repeated testing for SARS-CoV-2 by RT-qPCR done 48 and 53 days after the initial positive result.