Acute Corneal Endothelial Graft Rejection with Coinciding COVID-19 Infection

Purpose: To report a case of acute corneal endothelial graft rejection with concurrent onset of coronavirus disease 2019 (COVID-19) symptoms.

Observations: A 31-year-old African American female with a history of asthma, sleep apnea, obesity (BMI of 40), and bilateral keratoconus was noted to have acute corneal endothelial graft rejection three months after uncomplicated penetrating keratoplasty (PKP) of the left eye. The patient developed dysgeusia and subjective fever on the same day as ocular discomfort, and she was subsequently diagnosed with COVID-19 with only these two classic symptoms of the viral infection.

Conclusion: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause conjunctivitis and has demonstrated transmissibility through ocular secretions. Acute immune and inflammatory dysregulation have been seen in cases of COVID-19 through various mechanisms. COVID-19 infection may potentially compromise ocular immune privilege contributing to acute corneal graft rejection.