*Case Report* **Presentation of SARS-CoV-2 in a Pediatric Heart Transplant Recipient with Multiple Underlying Comorbidities**

**Bibhuti B. Das**

Department of Pediatric Cardiology, University of Mississippi Medical Center, Mississippi Children's Hospital, 2500 North State Street, Jackson, MS 39211, USA; bdas@umc.edu; Tel.: +1-601-984-5250; Fax: +1-601-984-5283

**Abstract:** A six-year-old heart transplant recipient with additional significant co-morbidities, including severe hypoxic-ischemic injury, gastrostomy, tracheostomy, and mechanical ventilation dependency, encountered SARS-CoV-2 infection. The patient received tacrolimus and mycophenolate to prevent graft rejection, presented initially with SARS-CoV-2 positive and presumed pseudomonas aeruginosa pneumonia. Twenty-three days later, the patient presented with fever recurrence with evidence for systemic inflammation, which resolved rapidly with high-dose methylprednisolone. Interestingly, while IgM to SARS-CoV-2 was present, IgG was not detected even three months after his first positive test for SARS-CoV-2. The author discusses potential immune mechanisms that might have affected the course of multi-system inflammatory syndrome children (MIS-C) in this patient.

**Keywords:** SARS-CoV-2; COVID-19; myocarditis; pediatric heart transplantation
