University of Florida College of Medicine Jacksonville, FL, United States
Amin Elfituri, MD, Firas Warda, MD, Leena Shahla, MD, Faisal Bukeirat, MD University of Florida College of Medicine, Jacksonville, FL
Introduction: We present a young male who was diagnosed with pancreatitis, found to have diabetic ketoacidosis, and later diagnosed with hypothyroidism. Our case presents the relationship between COVID-19 and autoimmunity. Coronavirus has been linked to autoimmune diseases. Pancreatic involvement in autoimmunity is poorly studied. Pancreatic involvement in autoimmunity is poorly studied.
Case Description/Methods: The patient is a 22-year-old male who presented to ER with nausea, vomiting, and abdominal pain. He reported a recent COVID-19 pneumonia. Pertinent history included weight loss, polyuria, polydipsia, for the 3 months. Vital signs were normal. Oxygen saturation was normal. Physical exam showed epigastric tenderness. Labs were consistent with ketoacidosis. Lipase was 2,322 Units/L, triglycerides were 387 mg/dL, hemoglobin A1c of 10.7%. Patient was on an insulin drip and intravenous hydration. TSH found to be 11.7 mUnits/L. Free T4 and free T3 were at 0.4 ng/dL and 0.8 pg/mL, respectively. Patient was discharged on levothyroxine and insulin. On further evaluation, C-peptide level was 0.3 ng/mL. Glutamic acid decarboxylase and thyroid peroxidase antibodies were positive, confirming the diagnosis of type I diabetes and thyroiditis.
Discussion: Covid 19 affects the respiratory tract, gastrointestinal involvement has been reported. The patient's pancreatitis and thyroiditis could have been due to direct cytopathic effects of SARS-COV-2 replication, or indirectly by systemic immune response. In a case series of 52 patients with COVID-19, serum lipase was found elevated in 17% of patients without symptoms. Another case series of 67 patients with COVID-19 pneumonia, reported a 17% incidence rate of pancreatitis, although only 7% of patients had significant pancreatic damage.
Regarding thyroidal disease, direct damage causes subacute thyroiditis. As the disease process progresses, hypothyroidism may last, especially in those with avidity to autoimmune disease.
Type I diabetes may arise in patients who have the antibodies, especially after a viral infection. In rare cases, the virus can infect the islet cells directly and destroy them permanently. Coxsackie virus has been studied in connection to developing type I diabetes, due to molecular mimicry. This phenomenon is poorly studied in covid-19 but it would be of no surprise if it is present.
It would be beneficial to monitor for autoimmune processes in patients who survived coronavirus disease as such processes can increase their morbidity if left unrecognized.
Amin Elfituri indicated no relevant financial relationships.
Firas Warda indicated no relevant financial relationships.
Leena Shahla indicated no relevant financial relationships.
Faisal Bukeirat indicated no relevant financial relationships.
Amin Elfituri, MD, Firas Warda, MD, Leena Shahla, MD, Faisal Bukeirat, MD. P1163 - Idiopathic Pancreatitis, Newly Diagnosed Diabetes Mellitus I, and Hypothyroidism in a Young Patient With Recent COVID-19 Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.