Achalasia Following a SARS-CoV-2 Infection and Recent COVID-19 Immunization in a 20-year-old Female

Abstract

Achalasia is an esophageal disorder characterized by loss of inhibitory neurons of the myenteric plexus in the lower esophageal sphincter, presenting with dysphagia, chest pain, and regurgitation. Although the etiology of achalasia is unknown, it has been associated with viral infections, and recent studies have noted concurrence of achalasia cases with COVID-19 infection. The case discussed in this report pertains to a 20-year-old female with a recent history of COVID-19 infection and subsequent SARS CoV-2 vaccine administration, presenting to the Emergency Department with a complaint of chest pain and shortness of breath. She was incidentally diagnosed with achalasia, after concern for pulmonary embolism prompted CT angiography of the chest. This case is unique due to the patient’s young age and lack of confounding ongoing medical issues to consider when analyzing disease presentation, as well as its potential link to COVID-19 infection. We hypothesize that SARS-CoV-2 might have caused a deviant immune response in this patient, leading to vagus nerve damage and the development of achalasia. With this case report, we hope to further explore the connection between COVID-19 and achalasia to help guide clinicians to potential viral etiologies of achalasia, allowing them for a prompt and efficient diagnosis and patient management.