Saint Michael's Medical Center Millburn, NJ, United States
Saraswathi Lakkasani, MD1, Mehul Shah, MD2, Noreen Mirza, MD2, Mohammad Nabil Rayad, MD2, byron S. Okwesili, MD2 1Saint Michael's Medical Center, Millburn, NJ; 2Saint Michael's Medical Center, Newark, NJ
Introduction: Autoimmune pancreatitis (AIP) is a rare diagnosis with a prevalence of 4.6% to 6%. Histologically, AIP in concurrence with Inflammatory Bowel Disease (IBD) often presents as Type 2 AIP. Interestingly, there has been an association between the onset of autoimmune disease after infection with Coronavirus disease 2019 (COVID-19). Here we present a unique case presenting with concomitant onset of ulcerative colitis (UC) and Type 2 AIP after COVID-19 infection.
Case Description/Methods: A 36-year-old male with recent COVID19 infection 2 weeks ago presented to clinic with complaints of vague abdominal pain, rectal pain and bleeding. He reported intermittent diarrhea and decreased appetite. He had lost 15 lbs over the prior 2 weeks. On physical exam he had vague periumbilical and left upper quadrant tenderness. Labs showed lipase of 1246.Computed tomography showed colitis of the cecum and ascending colon and a pancreatic tail lesion. Magnetic Resonance Imaging findings were suspicious for a possible pancreatic tail mass with superimposed acute pancreatitis. Colonoscopy showed cecal and rectal ulceration with pancolitis. Biopsies were consistent with UC. Endosonographic biopsy of pancreatic lesion showed moderate-severe chronic pancreatitis consistent with autoimmune pancreatitis type 2. Pt did well with steroids and now on follow up.
Discussion: Studies showed that concurrent disease with AIP and UC at a prevalence of 30-35% in Western countries. Patients with concurrent AIP-UC had a greater degree of severity and worse prognosis when compared to UC alone. The association between clearance of COVID-19 infection and the onset of autoimmune disease can be explained as, COVID-19 causes a significant decrease in T-lymphocytes (TL) including CD4+, CD8+ and regulatory TL which may be multifactorial and related to the induction of apoptosis, upregulation of inflammatory cytokines and bone marrow suppression. During the recovery phase, the lymphocyte levels increase which may trigger an immune reconstitution state where the immune system is hyperactive and unable to self-regulate. There is immunosuppression that occurs during COVID-19 infection causing a transient decrease in the ability of the innate immune system cells to identify differences in tissues. Overall, the development of autoimmune conditions such as IBD and AIP post COVID- 19 infection has not been well established. Also, this case illustrates the concomitant onset of both IBD and AIP which makes it a unique addition to the existing literature.
Figure: Inflammation in rectum.
Disclosures: Saraswathi Lakkasani indicated no relevant financial relationships. Mehul Shah indicated no relevant financial relationships. Noreen Mirza indicated no relevant financial relationships. Mohammad Nabil Rayad indicated no relevant financial relationships. byron Okwesili indicated no relevant financial relationships.
Saraswathi Lakkasani, MD1, Mehul Shah, MD2, Noreen Mirza, MD2, Mohammad Nabil Rayad, MD2, byron S. Okwesili, MD2. P2251 - COVID-Induced Expression of Gastrointestinal Tract Autoimmunity, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.