Fangfang Wang, MD1, Jennifer Horsley-Silva, MD2, Lucinda Harris, MD1 1Mayo Clinic, Scottsdale, AZ; 2Mayo Clinic Arizona, Scottsdale, AZ Introduction: Esophageal dysfunction is a common manifestation of systemic sclerosis (SS), resulting from progressive visceral collagen deposition, and neuronal and muscular dysfunction. GERD and dysphagia frequently suggest esophageal involvement due to disordered motility. De novo SS following 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 female 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 CT revealed non-UIP interstitial fibrosis.
GI evaluation showed marked esophageal involvement. High-resolution manometry demonstrated absent contractility and elevated LES pressure (possibly due to coughing and poor tolerance). Esophagram revealed tertiary contractions, distal stricture, and upstream dilation. EGD 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 EGJ 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 PPI 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.
Disclosures: Fangfang Wang indicated no relevant financial relationships. Jennifer Horsley-Silva indicated no relevant financial relationships. Lucinda Harris: Anyx – Grant/Research Support. Ardelyx – Consultant, Educational video. Gemelli Biotech – Advisory Committee/Board Member, Consultant. GI Health Foundation – Advisor or Review Panel Member. Rome – Member. Salix Pharmaceuticals – Consultant. Takeda – Grant/Research Support.
Fangfang Wang, MD1, Jennifer Horsley-Silva, MD2, Lucinda Harris, MD1. P2864 - Esophageal Stricture and Dysmotility Secondary to Systemic Sclerosis Following COVID-19 Vaccination, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
