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This article discusses the case of a heart transplant recipient who developed acute T-cell-mediated rejection following a confirmed SARS-CoV-2 infection. The patient's management was complicated by conflicting treatment goals for COVID-19 and transplant rejection. The autopsy revealed rapidly progressive graft vasculopathy and positive endothelial staining for SARS-CoV-2, suggesting that viral-associated endotheliitis may have contributed to the rejection. The article highlights the need for further research to guide the management of patients with concurrent SOT rejection and COVID-19. [Extracted from the article]