Jalal Dufani, MBBCh1, Madaen Abuhamidah, MBBCh2, Haitam M. Buaisha, MBBCh1, Sandeep Mukherjee, MD1; 1Creighton University School of Medicine, Omaha, NE; 2University of Tripoli, Omaha, NE
Introduction: There is a growing evidence that COVID 19 can present as a new- onset diabetes or severe metabolic complications of preexisting diabetes. The pathophysiology is still not well defined, but it is suggested that it is related to the ability of the virus to bind to binds to angiotensin-converting enzyme 2 (ACE2) receptors in different organs including the pancreases. Here, we present a 27-year-old female with COVID infection, acute pancreatitis of unknown etiology, and worsening hyperglycemia and diabetes ketoacidosis.
Methods: A 27-year-old female with past medical history of diabetes mellitus not on treatment, morbid obesity, and history of gallstone pancreatitis 6 years ago status post ERCP with sphincterotomy and laparoscopic cholecystectomy who presented with acute onset upper quadrant abdominal pain for one day. Physical exam was only significant for tenderness in the upper abdomen. Complete blood count was normal, blood glucose 474, sodium 130, CO2 21, normal kidney function, and Lipase of 1900. CT abdomen and pelvis showed acute interstitial pancreatitis. Patient refused admission at that time requesting to go home. One week later, she presented with worsening abdominal pain and generalized body aches. Denied any fever or cough and reported contact with family members with COVID-19. Testing was sent, and it came back positive. Her labs showed WBC 13K, CMP showed blood glucose 383, sodium, 131, Anion gap 17, K+ 3.3, AST 62, ALT 42, ALP 296, Lipase >7000, B-Hydroxybutyric Acid 60, CRP 400, and triglycerides 420. CTAP showed necrotizing pancreatitis involving >60% of the pancreatic parenchyma with no evidence of infection or abscess. The etiology of her pancreatitis was unclear as the patient denied any alcohol use and abdominal images failed to reveal any biliary pathology. She was admitted to ICU for acute pancreatitis and DKA management. Discussion: SARS-CoV-2 the virus which is the cause of COVID-19 binds Angiotensin-converting enzyme 2 (ACE2) receptors which is expressed in multiple human organ including pancreatic beta cells. Theoretically, this suggest the possibility that Covid-19 can cause acute pancreatitis, damages pancreatic islets, and potentially cause diabetes or worsening of preexisting diabetes. Our patient presentation with acute pancreatitis preceded the respiratory symptoms related to Covid-19. The severity of her hyperglycemia warranting higher doses of insulin and the metabolic abnormalities were beyond stress response associated with severe illness.
Figure I: Necrotizing pancreatitis with greater than 60% parenchymal involvement.
Disclosures: Jalal Dufani indicated no relevant financial relationships. Madaen Abuhamidah indicated no relevant financial relationships. Haitam Buaisha indicated no relevant financial relationships. Sandeep Mukherjee indicated no relevant financial relationships.