The bingo card for lasting symptoms from COVID-19 makes for a rich and diverse read. Some of the disease’s lasting ailments pertain to altered metabolic function, but a new case study has brought a rare and as of yet unreported condition to our attention: polyphagia. Known to most of us as overeating, the symptom was reported by a 41-year-old in Uganda who found that having recovered from COVID-19 she had an insatiable appetite resulting in weight gain. The authors of a paper about the presentation say that while it is a rare case, it could be one worth investigating for the benefit of others who may find themselves in a similar situation.
Post-acute COVID-19 syndromes (PACs) are still emerging even almost two years into the pandemic, and it’s likely there will be more to come. They relate specifically to persons who suffered symptomatic COVID-19, sometimes progressing to acute pneumonia. Nausea, diarrhea, stomach aches and loss of appetite have all been reported as symptoms of long COVID, but an insatiable appetite is a relatively new one for the disease.
The affected patient was a 41-year-old woman with no prior history of eating disorders who developed pneumonia as a result of a COVID-19 infection. After recovery, she noticed her appetite had changed significantly, leaving her excessively hungry and unable to control the volume of food she was ingesting. The uncontrollable eating caused her to gain 16 kilograms (35 pounds) in weight and develop increased blood sugar levels that were above the normal range.
“Her appetite spiked, and she started to eat more than usual, from two to three meals a day, depending on the situation,” wrote the case study authors. “She progressively increased the frequency and the amount of meals per day to two meals every 2 h during a day. This included frequent snacks and tea within the same period in a meal. She could eat the amount of food previously consumed by three members of her family.”
Exactly how COVID-19 could result in a lasting change to appetite like this isn’t yet known for certain, but the case study authors suspect it could have something to do with the central nervous system (CNS). COVID-19 can cause headache, dizziness, brain fog, and confusion, all of which pertain to the CNS. During acute infection, it’s possible that an infection in the CNS (known as meningoencephalitis) could affect neural tissue, disrupting important pathways. That which controls appetite could indeed be an affected path, resulting in a changed and increased diet as seen in this patient.
The study authors also suggest other pathways through which vascular damage and ischemia could cause post-COVID-19 polyphagia, or the possibility that it might not have been related to the infection at all.
“For individuals who have elevated appetite following the COVID-19 recovery, polyphagia should be a possible differential,” they concluded. “However, more studies are warranted to understand the etiology, diagnosis, and management of the post-acute COVID-19 syndromes related polyphagia.”