ABSTRACT: To date, uncertainty remains about how long the protective immune responses against SARSCoV- 2 persists and the first reports of suspected reinfection began to be described in recovered patients months after the first episode.1 Viral evolution may favor reinfections, and the recently described spike mutations, particularly in the receptor binding domain (RBD) in SARS-CoV- 2 lineages circulating in the UK, South Africa, and most recently in Brazil, have raised concern on their potential impact in infectivity and immune escape.2,3,4 We report the first case of reinfection from genetically distinct SARS-CoV-2 lineage presenting the E484K spike mutation in Brazil, a variant associated with escape from neutralizing antibodies.

A 45-year-old female healthcare executive, resident in Salvador, Bahia state, Northeast Brazil, with no comorbidities, presenting symptoms of viral infection on two occasions (May 26, 2020 and October 26, 2020). In the first episode, the patient presented diarrhea, myalgia, asthenia and odynophagia for approximately 7 days. She used 40 mg prednisone for 5 days and returned to activities 21 days later without sequelae or complaints. In the second episode, symptomatically more severe, the patient presented headache, malaise, diarrhea, cough and sore throat that evolved to myalgia and respiratory distress, ageusia, muscle fatigue, insomnia, mild dyspnea on exertion and shortness of breath.

DOI: 10.20944/preprints202101.0132.v1

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