{Reference Type}: Case Reports
{Title}: Critical Presentation of a Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection: A Case Report.
{Author}: Massanella M;Martin-Urda A;Mateu L;Marín T;Aldas I;Riveira-Muñoz E;Kipelainen A;Jiménez-Moyano E;Rodriguez de la Concepción ML;Avila-Nieto C;Trinité B;Pradenas E;Rodon J;Marfil S;Parera M;Carrillo J;Blanco J;Prado JG;Ballana E;Vergara-Alert J;Segalés J;Noguera-Julian M;Masabeu À;Clotet B;Toda MR;Paredes R;
{Journal}: Open Forum Infect Dis
{Volume}: 8
{Issue}: 7
{Year}: Jul 2021
{Factor}: 4.423
{DOI}: 10.1093/ofid/ofab329
{Abstract}: <B>BACKGROUND: </B>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfections have been reported; however, most cases are milder than the primary infection. We report the first case of a life-threatening critical presentation of a SARS-CoV-2 reinfection.<BR><B>METHODS: </B>A 62-year-old man from Palamós (Spain) suffered a first mild coronavirus disease 2019 (COVID-19) episode in March 2020, confirmed by 2 independent SARS-CoV-2 nasopharyngeal polymerase chain reaction (PCR) assays and a normal radiograph. He recovered completely and tested negative on 2 consecutive PCRs. In August 2020, the patient developed a second SARS-CoV-2 infection with life-threatening bilateral pneumonia and Acute respiratory distress syndrome criteria, requiring COVID-19-specific treatment (remdesivir + dexamethasone) plus high-flow oxygen therapy. Nasopharyngeal swabs from the second episode were obtained for virus quantification by real-time PCR, for virus outgrowth and sequencing. In addition, plasma and peripheral blood mononuclear cells during the hospitalization period were used to determine SARS-CoV-2-specific humoral and T-cell responses.<BR><B>RESULTS: </B>Genomic analysis of SARS-CoV-2 showed that the virus had probably originated shortly before symptom onset. When the reinfection occurred, the subject showed a weak immune response, with marginal humoral and specific T-cell responses against SARS-CoV-2. All antibody isotypes tested as well as SARS-CoV-2 neutralizing antibodies increased sharply after day 8 postsymptoms. A slight increase of T-cell responses was observed at day 19 after symptom onset.<BR><B>CONCLUSIONS: </B>The reinfection was firmly documented and occurred in the absence of robust preexisting humoral and cellular immunity. SARS-CoV-2 immunity in some subjects is unprotective and/or short-lived; therefore, SARS-CoV-2 vaccine schedules inducing long-term immunity will be required to bring the pandemic under control.