Abstract
Here, we report a case of acute endothelial graft rejection following coronavirus disease 2019 (COVID-19). A 57-year-old woman who underwent therapeutic penetrating keratoplasty for a perforated infectious corneal ulcer in her right eye developed severe acute respiratory syndrome coronavirus 2 infection, which required intensive care and treatment with steroids. Acute endothelial graft rejection was seen at three weeks postoperatively and managed with high-dose corticosteroids. Despite standard therapy, secondary graft failure was observed. Immune dysregulation associated with COVID-19 may be a significant cause of acute endothelial graft rejection among keratoplasty patients with COVID-19.