Autoimmune gastrointestinal dysmotility following SARS-CoV-2 infection successfully treated with intravenousimmunoglobulin

ABSTRACT

Objective: To describe a severe case of autoimmune gastrointestinal dysmotility (AGID) following SARS-CoV-2 infection responsive to intravenous immunoglobulin (IVIG). Background: Autoimmune gastrointestinal dysmotility is a limited form of dysautonomia that can be paraneoplastic or idiopathic, sometimes preceded by a viral infection. Design/Methods: We present the case of a 17-year old female with celiac disease who developed intractable nausea and early satiety after SARS-CoV-2 infection. Over ten months, she required nasogastric and nasoduodenal tube feedings and finally was advanced to total parenteral nutrition to meet her caloric needs. Her α3 nicotinic ganglionic acetylcholine and anti-striational antibodies were mildly elevated. Gastrointestinal transit scintigraphy studies showed delayed gastric emptying and slowed small bowel transit. Thermoregulatory stress test showed areas of anhidrosis consistent with autonomic sudomotor impairment. Results: Following IVIG treatment, the patient's symptoms improved and she was able to tolerate full oral diet. This was reflected by improvement of objective testing including transit studies and a repeat thermoregulatory sweat test. Conclusions: AGID should be considered as part of the differential diagnosis in patients with subacute GI dysmotility, a recent viral illness, and evidence of family or personal history of autoimmunity. SARS-CoV-2 infection may be associated with AGID. An immunotherapy trial in the appropriate clinical setting can be helpful in establishing the diagnosis and can result in meaningful recovery. This is the first report of AGID occurring after SARS-CoV-2 infection. The dramatic response to IVIG emphasizes the importance of early recognition and the reversible nature of this condition.