Mayra Montalvo1, Padmini Nallapaneni2, Sara Hassan3, Samuel Nurko4, Sean J Pittock1, Julie Khlevner2. 1. Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. 2. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA. 3. Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mayo Clinic, Rochester, Minnesota, USA. 4. Center for Motility and Functional Gastrointestinal Disorders Boston Children's Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Autoimmune gastrointestinal dysmotility (AGID) is a limited form of dysautonomia that can be paraneoplastic or idiopathic. Some presentations can be preceded by a viral infection. METHODS: We report a case of a 17-year-old girl that developed intractable nausea and early satiety after SARS-CoV-2 infection. KEY RESULTS: 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 sweat test showed areas of anhidrosis consistent with autonomic sudomotor impairment. After IVIG treatment the patient's symptoms improved dramatically and she was able to tolerate full oral diet. This was reflected by improvement of her baseline transit studies and the thermoregulatory sweat test. CONCLUSIONS AND INFERENCES: 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 and treatable nature of this condition.
BACKGROUND: Autoimmune gastrointestinal dysmotility (AGID) is a limited form of dysautonomia that can be paraneoplastic or idiopathic. Some presentations can be preceded by a viral infection. METHODS: We report a case of a 17-year-old girl that developed intractable nausea and early satiety after SARS-CoV-2 infection. KEY RESULTS: 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 sweat test showed areas of anhidrosis consistent with autonomic sudomotor impairment. After IVIG treatment the patient's symptoms improved dramatically and she was able to tolerate full oral diet. This was reflected by improvement of her baseline transit studies and the thermoregulatory sweat test. CONCLUSIONS AND INFERENCES: 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 and treatable nature of this condition.
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