P1105 - Acute Pancreatitis Secondary to SARS-CoV-2

Joseph J. Alukal, MD¹, Stan A. Mani, MBBS², Ejo John, MD¹, Ranjit Makar, MD^3
1Valley Health System, Las Vegas, NV; ²Father Muller Medical College, Austin, TX; ³University of Nevada Las Vegas, School of Medicine, Las Vegas, NV

Introduction: Acute pancreatitis secondary to SARS-CoV-2 is extremely rare (< 1 % incidence).We report a case of acute pancreatitis in a female patient who presented to the ER one week after she was hospitalized with COVID-19 pneumonia.

Case Description/Methods: A 59 year old female with no medical comorbidities was admitted to the hospital for shortness of breath.She was diagnosed with COVID-19 pneumonia based on RT-PCR testing and CT chest revealed bilateral patchy infiltrates.She was hospitalized, treated with dexamethasone and subsequently discharged on home oxygen after a 2 day stay. After going home she improved symptomatically, however after 7 days presented to back to the ER with severe epigastric pain and vomiting.Blood work revealed elevated serum lipase of 1709 units/L (73-393 U/L), and normal BUN. She denied alcohol consumption. CT scan of the abdomen revealed pancreatitis involving the head and proximal body, with no evidence of pancreatic divisum or pancreatic duct stones. LFTs were normal and ultrasound of the gallbladder did not show any stones in the biliary tree. Based on Atlanta Classification she was diagnosed with mild acute pancreatitis and treated with symptomatic care. Work up revealed normal triglyceride level, and negative viral titers for hepatitis CMV, HSV (IgM) and ANA panel.Work up was also negative for autoimmune pancreatitis.After 36 hours her symptoms improved and was discharged home.

Discussion: Although COVID-19 predominantly manifests with respiratory symptoms, gastrointestinal complaints are not uncommon.However, it appears that pancreatitis secondary to COVID-19 is a very rare complication. One large study that analyzed 11,883 patients hospitalized with COVID-19 reported that the prevalence pancreatitis was only 0.27%. The exact mechanism of pancreatitis induced by SARS-CoV-2 is unknown, however it has been suggested that the expression of ACE-2 receptors on pancreatic islet cells can serve as a focus of entry for the virus. In our case, the temporal relationship between diagnosis of COVID-19 pneumonia and epigastric pain raised the possibility of SARS-CoV-2 induced pancreatitis. Moreover, we were able to exclude other precipitating factors such as drugs, alcohol, triglycerides, gallbladder/pancreatic duct stones, autoimmune pancreatitis and other viral agents. Our case highlights that physicians should be aware about GI symptoms in COVID-19 patients and obtain lipase levels in those with abdominal pain so that pancreatitis can be diagnosed early and effectively managed.


Figure: Induration seen on the head and body of the pancreas consistent with acute pancreatitis


Disclosures:
Joseph Alukal indicated no relevant financial relationships.
Stan Mani indicated no relevant financial relationships.
Ejo John indicated no relevant financial relationships.
Ranjit Makar indicated no relevant financial relationships.


Joseph J. Alukal, MD¹, Stan A. Mani, MBBS², Ejo John, MD¹, Ranjit Makar, MD³. P1105 - Acute Pancreatitis Secondary to SARS-CoV-2, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.