A case report on a possible link between SARS-CoV-2 infection and gastric pathology onset

Many organs have been described as involved in long-COVID processes. Concerning the stomach, few cases have been reported and discussed. Particularly, we have very few information about the potential direct damage to the gastric mucosa caused by SARS-CoV-2. We report the case of a 45-year-old Italian woman with no known chronic diseases or food intolerances who developed severe gastrointestinal manifestations as long COVID-19 manifestation following a SARS-CoV-2 infection. During the acute phase of COVID-19, she exhibited, among other symptoms including respiratory ones, an intense vasculitis affecting the superficial veins of the lower limbs and near-total desquamation of the lingual epithelium. Treatment with corticosteroids (betamethasone) led to complete remission in a few days. However, after recovery, she suddenly developed worsening heartburn and esophageal reflux. A year later, she was diagnosed with severe gastritis and mild dysplasia of the gastric body. Anamnesis revealed new-onset food intolerances to gluten-containing food and dairy foods. Histological examination showed Helicobacter pylori (HP) infection. After eradication therapy and dietary modifications, her gastric inflammation regressed, and dysplasia resolved. We hypothesize that SARS-CoV-2 may have triggered disruption of the gastric mucosa homeostasis, in turn leading to both food intolerances and HP proliferation. This case raises the question of whether SARS-CoV-2-induced molecular mimicry mechanisms may have long-term consequences on the gastric muco-microbiotic layer and in turn on the whole gastric homeostasis.