Introduction: Burns are significant injuries that cause a cascade of inflammatory responses. Patients with large burns and inhalation injury often experience respiratory failure, renal failure, liver dysfunction, and sepsis. The COVID-19 virus has added a unique challenge as a current or recent COVID-19 infection seems to lend to worse outcomes, However, we do not yet have enough data to understand the full implication of COVID-19 on burn patients. Description: A 41-year-old man with no remarkable medical history was admitted to the Burn Intensive Care Unit (BICU) with 58% body surface area burns with smoke inhalation. He was given appropriate burn resuscitation and placed on the volumetric diffusive respirator (VDR). Admission COVID-19 PCR was negative, and COVID-19 Spike IgG was 12 IU/mL. Both labs and vital signs remained stable and he went to the OR on hospital day 4 for excision and grafting and the first 24 hours post-op were unremarkable. On post-op day 1, he had an abrupt rise in lactate with worsening acidosis. Sepsis guidelines were followed and he required initiation of renal replacement therapy (CRRT) along with bedside laparotomy with no significant findings. Repeat lab work showed a COVID-19 Spike IgG level >800. Patient’s conditioned worsened despite maximal medical intervention, and he died on hospital day 8. Since the sudden, rapid decline in patient’s condition at this point in his hospitalization is somewhat atypical, we theorize that patient was either admitted with COVID-19 infection that was undetectable, or this was a nosocomial infection. Though he had no significant comorbidities, it certainly seems that this new infection unduly stressed his immune system, leading to multi-system organ failure and death. Discussion: Large burn injuries are often challenging to manage, but improved therapies and treatments have led to increasingly good outcomes. The addition of current or recent COVID-19 infection adds a new challenge which needs further study as we learn more about the inflammatory and long-term implications of this disease on lung function and immune systems. Our experience of rapid onset organ failure and death in a burn patient with likely new COVID-19 infection presented a unique burn and critical care management challenge that needs further study.