Short communication Child with liver transplant recovers from COVID-19 infection. A case report Aure ´ lie Morand a,b, *, Bertrand Roquelaure c , Philippe Colson b,d , Sophie Amrane b,d , Emmanuelle Bosdure a , Didier Raoult b,d , Jean-Christophe Lagier b,d , Alexandre Fabre c,e a Department of Infant Medicine and Specialized Pediatrics, Aix Marseille University, La Timone Children Hospital, AP–HM, 278, rue Saint-Pierre, 13005 Marseille, France b Aix Marseille University, IRD, AP–HM, MEPHI, 13005 Marseille, France c Department of Pediatric Gastroenterology and Hepatology, Multidisciplinary pediatric, Aix Marseille University, La Timone Children Hospital, AP–HM, 13005 Marseille, France d IHU-Me ´diterrane ´e Infection, 13005 Marseille, France e Inserm, MMG, Aix Marseille Univ, 13005 Marseille, France We herein present the case of a 55-month-old girl who was infected with coronavirus disease 2019 (COVID-19) 5 months after undergoing liver transplantation. After an uneventful birth at term, she was diagnosed with congenital cholestasis due to biliary atresia and underwent Kasai portoenterostomy (KPE) at 53 days of age. KPE was partially successful, but in the following years she developed portal hypertension with refractory ascites and angio- cholitis. Liver transplantation (from her father) was performed without major complications at the age of 50 months. The patient was discharged 20 days after the procedure on tacrolimus immunosuppression therapy and with no immunization against Epstein–Barr virus (EBV) before the transplantation. She had mildly elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (approx. 1.5 of upper limit of normal [ULN]) levels, but normal bilirubin and gamma glutamyl transfer- ase (GGT) levels. A mild increase in the GGT level (approx. 2 ULN) after 96 days of transplantation prompted magnetic resonance imaging (MRI) and ultrasound (US) examinations, which showed a mild dilatation of the intrahepatic biliary tract possibly linked to an anastomotic stenosis. Moreover, the girl presented with an asymptomatic EBV primary infection linked to the transplantation (the father was EBV positive) with a high viral load in the blood. A radiological angioplasty procedure was planned. She weighed approximately 15 kg and her usual treatment consisted of tacrolimus (0.07 mg/kg b.i.d.), acetylsalicylic acid (4.7 mg/kg qd), and ursodeoxycholic acid (10 mg/kg b.i.d.). A few days before the child’s presentation, the mother, a 29- year-old woman with no medical history, presented with rhinopharyngitis. She felt progressively tired and had a fever, cough, polypnea, thoracic pain, and headache. She was referred to the Me ´ diterrane ´e Infection University Hospital Institute where she was diagnosed with COVID-19 by RT-PCR of a nasopharyngeal swab [1]. She was hospitalized in the Contagious Infections Diseases Department. Low-dose computed tomography showed bilateral, asymmetrical, peripheral frosted-glass images and two alveolar condensation foci in two different segments of the right lung. This was compatible with COVID-19 pneumonia. The mother was treated with oral hydroxychloroquine and oral azithromycin [2]. On the fourth day of treatment, the results of her Archives de Pe ´ diatrie xxx (2020) xxx–xxx * Corresponding author at: Department of Infant Medicine and Specialized Pediatrics, Aix Marseille University, La Timone Children Hospital, AP–HM, 278, rue Saint-Pierre, 13005 Marseille, France. E-mail address: aurelie.morand@ap-hm.fr (A. Morand). A R T I C L E I N F O Article history: Received 15 April 2020 Received in revised form 27 April 2020 Accepted 2 May 2020 Available online xxx Keywords: COVID-19 Children Liver graft Biliary atresia A B S T R A C T We present the case of a 55-month-old girl who recovered from coronavirus disease 2019 (COVID-19) infection 5 months after undergoing liver transplantation; she had a co-infection with Epstein–Barr virus (EBV). To the best of our knowledge, this is the first case report of a COVID-19 infection in a pediatric patient with liver transplantation. Additionally, this is also the first report of confirmed co-infection between COVID-19 and EBV. On the basis of this case, we suggest that liver transplantation is not associated with COVID-19 symptom severity and development. Moreover, COVID-19 and EBV co- infections do not seem to aggravate the clinical outcome.  C 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved. G Model ARCPED-4823; No. of Pages 2 Please cite this article in press as: Morand A, et al. Child with liver transplant recovers from COVID-19 infection. A case report. Archives de Pe ´ diatrie (2020), https://doi.org/10.1016/j.arcped.2020.05.004 Available online at ScienceDirect www.sciencedirect.com https://doi.org/10.1016/j.arcped.2020.05.004 0929-693X/  C 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.