Abdul Al-Douri, MD, Jaison John, MD, Deepak Agrawal, MD; University of Texas, Austin, TX
Introduction: The current novel SARS-CoV2, or Coronavirus (COVID-19), pandemic has recorded nearly 7 million cases worldwide. Acute pancreatitis is a frequent reason for hospitalization with alcohol and gallstones being the most common etiology. Viral infection is less commonly seen accounting for < 10% of cases typically due to cytomegalovirus (CMV), Coxsackie B, and Hepatitis B. We present a case of a patient with acute pancreatitis co-infected with the novel coronavirus.
Methods: 45-year-old woman with medical history of type 2 diabetes mellitus, hypertension, and dyslipidemia presented with 3-day history of abdominal pain, nausea, and vomiting. She reported diffuse abdominal pain, worse on the right side, and the inability to urinate over the past 4 days. She reported mild dyspnea without any other respiratory symptoms. On exam, the patient had diffuse tenderness to palpation of the abdomen. Pertinent labs included a white blood cell count of 12.2, creatinine of 10.1 mg/dL (baseline creatinine 1.3 mg/dL), and lipase of 2,224 units/L (8-78 units/L). Liver function panel showed slightly elevated alkaline phosphatase at 257 units/L (42-121 units/L) while the rest of her LFT’s were normal. She was found to be SARS-CoV2 positive by nasopharyngeal swab. Chest x-ray revealed a left lower lobe infiltrate while CT abdomen and pelvis demonstrated cholelithiasis without evidence of acute cholecystitis, along with distal peripancreatic inflammation. Biliary duct size was normal at 4mm. The patient was initially treated with bowel rest and intravenous fluids infused at 200 ml/hr. Over the next few days her abdominal pain improved, she was able to tolerate a diet, and her kidney function also returned to baseline. She also received supportive treatment with prior to being discharged. Discussion: There is currently one case series discussing COVID-19 associated acute pancreatitis. Hadi et al described three family members admitted to the ICU in March 2020 with acute respiratory distress syndrome (ARDS) from COVID-19, and two of the three patients were found to also have acute pancreatitis. Our patient did have cholelithiasis but there was no evidence of gallstone obstruction, and other causes such as alcohol, drugs, hypertriglyceridemia, and hypercalcemia were ruled out. We are presenting this case report to highlight a possible relationship between the novel coronavirus and the development of acute pancreatitis.
Disclosures: Abdul Al-Douri indicated no relevant financial relationships. Jaison John indicated no relevant financial relationships. Deepak Agrawal indicated no relevant financial relationships.