Sex: M
Vaccine: COVID19
Symptoms: Computerised tomogram thorax, Drug ineffective, Oesophagram, SARS-CoV-2 test
Clinical narrative: LACK OF EFFECT; This spontaneous report was received from literature.  The brand name was not reported and hence it was assumed to be J and J for reporting purposes. Acute esophageal necrosis (AEN) may be a potential complication of Coronavirus Disease 2019 (COVID-19). COVID-19 has been associated with a variety of sequelae, including acute respiratory distress syndrome, myocarditis, and thromboembolic events. The incidence rate of AEN is low as it is; only .01% to .28% of patients undergoing esophagogastroduodenoscopy (EGD) are found to have AEN. This report concerned a 43 year old male. The patient's height, and weight were not reported. The patient's concurrent conditions included: chronic alcohol-induced pancreatitis, GERD (Gastroesophageal reflux disease), and heavy cigarette use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number was not reported) dose, start therapy date were not reported for covid-19 prophylaxis. No concomitant medications were reported.  The patient was presented to the Emergency Department with epigastric abdominal pain, nausea, vomiting, diarrhea, and myalgias. On physical exam, patient was tachycardiac, afebrile, normotensive, and had diffuse abdominal tenderness with voluntary guarding and distention. Patient's CT (computerized tomography) chest, bilateral multifocal patchy ground glass opacities were found. A polymerase chain reaction COVID-19 test was found to be positive on admission (captured as lack of effect). The patient developed persistent fevers, hypoxia, tachycardia, and hypotension; CT chest found bilateral pleural effusions and a right anterior pneumothorax. A right-sided pig-tail chest tube was placed. A CT esophagram showed high-density material exiting the distal third of the esophagus within 5 cm (cm) of the gastroesophageal junction, concerning for esophageal perforation. Patient was then emergently taken to the operating room with Thoracic Surgery. An upper gastrointestinal (GI) endoscopy was performed by Thoracic Surgery revealed diffuse ischemic and necrotic mucosa beginning approximately 20 cm from the teeth and extending distally, and a large distal esophageal intra-abdominal fluid collections, and the placement of a venting gastrostomy tube and a feeding jejunostomy tube for nutritional access. Patient was discharged on a clear diet post operative day 27. The study concluded that the young age of the patient compels an unusual presentation of AEN. The case was complicated by esophageal perforation, which is seen in about 5 percent of AEN cases and is characteristic of severely ill patients. COVID-19 may have a causative role in the development of AEN in the patient. While risk factors such as male sex, and comorbidities including a history of necrotizing pancreatitis, alcohol use disorder, and GERD are present, they do not typically result in AEN in a patient of this young. COVID-19 may not be the only factor that led to AEN in the patient, but it may have played a critical pathophysiologic role. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the lack of effect was not reported. This report was serious (Other Medically Important Condition).; Sender's Comments: V0;  Drug ineffective; The event is a special reporting situation and owing to its nature, it is not possible to attribute this occurrence to the suspect vaccine. Hence, the causality is considered as not related.