Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA.
Neurogastroenterol Motil. 2022 Jul;34(7):e14314. doi: 10.1111/nmo.14314. Epub 2022 Jan 4.
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.
We report a case of a 17-year-old girl that 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 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.
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.
自身免疫性胃肠动力障碍（AGID）是一种局限性自主神经功能障碍，可继发于肿瘤或特发性疾病。某些表现可能先于病毒感染。
我们报告了一例 17 岁女孩在感染 SARS-CoV-2 后出现难治性恶心和早饱。
在十个月的时间里，她需要经鼻胃管和经鼻十二指肠管喂养，最终需要全胃肠外营养以满足其热量需求。她的α3 烟碱型乙酰胆碱和抗横纹肌抗体轻度升高。胃肠传输闪烁显像研究显示胃排空延迟和小肠传输减慢。体温调节出汗试验显示无汗区，提示自主副交感神经运动功能障碍。静脉注射免疫球蛋白（IVIG）治疗后，患者症状显著改善，能够耐受全口服饮食。这反映在她的基础转运研究和体温调节出汗试验的改善上。
这是首例 SARS-CoV-2 感染后发生 AGID 的报告。IVIG 的显著疗效强调了早期识别的重要性，以及这种情况具有可逆性和可治疗性。
