S4328 Esophageal Stricture and Dysmotility Secondary to Systemic Sclerosis Following COVID-19 Vaccination

Introduction: Esophageal dysfunction is a common manifestation of systemic sclerosis (SS), resulting from progressive visceral collagen deposition, and neuronal and muscular dysfunction. gastroesophageal reflux disease and dysphagia frequently suggest esophageal involvement due to disordered motility. De novo SS following coronavirus disease 2019 (COVID-19) vaccination is exceedingly rare. While a few cases of morphea and diffuse cutaneous SS have been reported, systemic multi-organ involvement remains largely undocumented. We present a unique case of SS with significant esophageal and multi-organ involvement post–COVID-19 vaccination. Case Description/Methods: An 82-year-old woman received her second Moderna COVID-19 vaccine in February 2021. Within weeks, she developed dysphagia to solids and liquids, regurgitation, early satiety, altered bowel habits, and weight loss. She also experienced progressive joint stiffness, swelling, and skin tightening. Initially misdiagnosed as rheumatoid arthritis based on elevated rheumatoid factor, she also tested positive for anti-PL-12 and SSA-52 antibodies. Her symptoms progressed, and she was later diagnosed with systemic sclerosis after worsening diffuse cutaneous thickening—previously thought to be edema. Chest computed tomography revealed non-UIP interstitial fibrosis. GI evaluation showed marked esophageal involvement. High-resolution manometry demonstrated absent contractility and elevated lower esophageal sphincter pressure (possibly due to coughing and poor tolerance). Esophagram revealed tertiary contractions, distal stricture, and upstream dilation. Esophagogastroduodenoscopy showed LA grade B esophagitis, foamy stasis, lower esophagus stricture and a dilated esophagus. EndoFLIP™ revealed a normal distensibility index (3.7–5.3 at 60 mL), absent contractility, and a maximum esophagogastric junction diameter of 14 mm. Balloon dilation up to 18 mm was performed. Follow-up endoscopies showed improved esophagitis and gradual symptom relief after serial dilations to 20 mm. She was treated with high-dose BID proton pump inhibitors and referred to a scleroderma center. Discussion: This case highlights a rare case of de novo systemic sclerosis with multi-organ involvement following COVID-19 vaccination. Although COVID-19 vaccines are generally safe, rare autoimmune responses can occur and clinicians should be cognizant of this possibility. Esophageal dysfunction is a frequent and debilitating SS manifestation, impairing peristalsis and predisposing to esophagitis and strictures. Early diagnosis with motility test, endoscopic stricture dilation to larger diameter, and multidisciplinary care are essential for optimal outcomes.