St. Mary Mercy Hospital Livonia, MI, United States
Zarak Hassan Khan, MD1, Stefan Odabasic, MD1, Kashif Mukhtar, MD1, George Roman, MD1, Khwaja F. Haq, MD2, Shania Chishti, 3, Charles Jaiyeoba, MD1 1St. Mary Mercy Hospital, Livonia, MI; 2Stony Brook University Hospital, Stony Brook, NY; 3Newcastle University Medicine, Gelang Patah, Johor, Malaysia
Introduction: Acute pancreatitis (AP) caused by viral infections such as Epstein-Barr Virus, mumps, measles, coxsackie, and Hepatitis-A virus has been well established in literature. AP in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, infection has also been reported in both retrospective cohort studies and case reports, although the real prevalence is unknown. Co-existing SARS-CoV-2 infection in patients with AP is associated with increased mortality and morbidity. We present the case of acute pancreatitis in a patient with recent COVID-19 infection.
Case Description/Methods: 71-year-old male with history of ESRD on hemodialysis status-post renal transplant on chronic prednisone, atrial fibrillation on apixaban, aortic stenosis, DM-2, gout, hypothyroidism, and recent history of COVID-19 infection presented to the hospital with acute epigastric abdominal pain which was sharp and non-radiating. Patient denied any history of alcohol use. Of note, he had a recent history of COVID-19 infection and was discharged from the hospital 3 days before. Patient had completed a course of Remdesivir and had also received Tocilizumab at that time. He was discharged on a 10-day course of dexamethasone. Patient's vital signs on presentation were within normal limits. Lab work was significant for a lipase of 5282. CT scan of the abdomen showed findings consistent with acute pancreatitis (Image 1). Patient was kept n.p.o and managed with aggressive IV fluid resuscitation as well as IV pain medications. Further workup included a TG level which was 467. Patient’s condition continued to improve, and he was discharged on fourth day of admission.
Discussion: SARS-CoV-2 requires ACE2 receptors for entering human cells and for priming it requires TMPRSS2. These proteins are found in abundance in the GI epithelium. ACE2 is also found in Pancreatic acinar, islet and ductal cells therefore it is a possibility that the virus can spread from the small intestinal wall into the pancreas resulting in pancreatitis. Although very uncommon, steroids induced pancreatitis has also been previously reported. However, drug induced pancreatitis is usually seen within 4-14 days of started the medication. Our patient was on steroids for almost 20 years. Even though AP has been reported in patients with COVID-19 infection, the association is not based on evidence. Therefore, solid multi-centered studies should be conducted to further evaluate this possible association.
Figure: Image 1: Yellow arrows demonstrating edematous body and tail of the pancreas with subtle surrounding fat stranding.
Disclosures: Zarak Hassan Khan indicated no relevant financial relationships. Stefan Odabasic indicated no relevant financial relationships. Kashif Mukhtar indicated no relevant financial relationships. George Roman indicated no relevant financial relationships. Khwaja Haq indicated no relevant financial relationships. Shania Chishti indicated no relevant financial relationships. Charles Jaiyeoba indicated no relevant financial relationships.
Zarak Hassan Khan, MD1, Stefan Odabasic, MD1, Kashif Mukhtar, MD1, George Roman, MD1, Khwaja F. Haq, MD2, Shania Chishti, 3, Charles Jaiyeoba, MD1. P2189 - Acute Pancreatitis Following SARS-CoV-2 Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.