Acute Corneal Endothelial Graft Rejection With Coinciding COVID-19 Infection

Cornea. 2021 Jan;40(1):123-124. doi: 10.1097/ICO.0000000000002556.


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

Methods: Case report.

Results: A 31-year-old African American woman with a history of asthma, sleep apnea, obesity (body mass index of 40), and bilateral keratoconus was noted to have acute corneal endothelial graft rejection 3 months after uncomplicated penetrating keratoplasty 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 2 classic symptoms of the viral infection.

Conclusions: Severe acute respiratory syndrome coronavirus 2 is known to cause conjunctivitis and has demonstrated transmissibility through ocular secretions. Acute immune and inflammatory dysregulations 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.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • COVID-19 / diagnosis*
  • COVID-19 / etiology
  • COVID-19 Testing
  • Dysgeusia / diagnosis
  • Endothelium, Corneal / pathology*
  • Female
  • Graft Rejection / diagnosis*
  • Graft Rejection / etiology
  • Humans
  • Keratoconus / surgery*
  • Keratoplasty, Penetrating*
  • Polymerase Chain Reaction
  • Reoperation
  • SARS-CoV-2*
  • Visual Acuity / physiology