SARS-COV2 and eosinophilic esophagitis: a first case

Abstract

Since it was initially reported on 31st December 2019, the disease known as coronavirus disease (COVID-19) has spread across the globe, and Italy was the first European country to face the consequences. The clinical and psychological impact of COVID-19 infection in eosinophilic gastrointestinal diseases (EGID) patients in Italy has been described. All consecutive EGID patients attending the University Hospital of Salerno and Padua filled an ad hoc COVID-19 survey. The study population included 102 EGID patients, of whom 89 had eosinophilic esophagitis (EoE), nine had gastroenteritis, and four had colitis. No patient was diagnosed with COVID-19 or had recurrence of his/her primary disease [1]. Other Italian authors observed that none of the 36 adult patients with EoE living in Siena and its Province were hospitalized or referred for COVID-19 infection between March and June 2020 [2]. Some reports indicate that atopy does not represent a risk factor for COVID-19 severity [3]. We described the first case of COVID-19 infection in a 21-year-old EoE patient. He was diagnosed with EoE in 2011. He was affected also by allergy to lentils and showed some episodes of oral allergy syndrome with different fruit and vegetables (tomato, peanut, soy, apple). It was then demonstrated sensitization to lipid transfer protein (Pru p3 2.94 kU/l), while sensitization to specific food storage protein, PR-10 (Bet v1 0.01 kU/l) and Profilin (Bet v2 0 kU/L) was excluded. On 16th October, the patient started complaining of asthenia, headache, anosmia and loss of taste. The diagnosis of COVID-19 infection was then confirmed with molecular assay of nasopharyngeal swab. The infection then affected the cohabiting parents in the following days. The mother was the only one who needed hospitalization for respiratory assistance. Before the infection, he was following therapy with oral viscous budesonide: 15 ml twice a day (2 mg/10 ml) for 5 months and he was following a legumes-free diet. The patient then discontinued budesonide therapy and received azithromycin therapy (500 mg per day for 5 days). He never needed respiratory assistance or oxygen therapy. He performed other two nasopharyngeal swabs and the negativity for E gene, RdRP/S gene and N gene was demonstrated on 8th November 2020. To our knowledge, this is the first case of COVID-19 in EoE patient. Eosinophils, for a long time identified as an effector cell in allergic diseases, recently has been postulated to play a potential role in antiviral responses. Several data indicate that patient with severe form of COVID-19 show a trend towards eosinopenia, leading to consider this condition a biomarker of poor prognosis; on the other hand, the higher proportion of activated eosinophils that characterized allergy may play a protective role [4]. In our patient’s last blood count, about 5 months before the infectious event, the peripheral blood eosinophil count was in the normal range (0.46 × 103/μl; 4.8% of white blood cells). Our case is the only one among a total of 125 EoE patients (0.8%), followed by EoE task force of our hospital. It should be remembered that worse prognoses of COVID-19 are more frequent in older patients than the average age of EoE patients. In Italy, data from Istituto Superiore di Sanità (data updated on 16th December 2020) shows that the median age of patients’ positive for COVID19 is 48 years and that the median age of patients who died with the same condition is 82 years [5]. It is therefore appropriate to moderate excessively optimistic immunological conclusions for patients with EoE, but it is possible just to describe a more reassuring reality. Acknowledgements The article submitted represents original work and has not been previously published or simultaneously submitted elsewhere for publication. The article has been read and approved by all authors. Our study has not been sponsored or funded. None academic bodies, and/or pharmaceutical (or other) companies have supported this work, in whole or in part. Conflicts of interest There are no conflicts of interest.