P2183 - A Rare Presentation of Acute Pancreatitis in Mild Coronavirus Disease 2019 Infection

Brianna L. Hatch-Vallier, DO¹, Fadi Hawa, MD², Vijay Jarodiya, MD¹, Rebecca Daniel, MD, DipABLM^3
1Saint Joseph Mercy Ann Arbor, Ann Arbor, MI; ²St. Joseph Mercy Ann Arbor, Macomb, MI; ³St. Joseph Hospital, Ann Arbor, MI

Introduction: Viral-induced pancreatitis has previously been well-defined, however there is limited data regarding the association between Coronavirus Disease 2019 (COVID-19) and pancreatitis. A handful of cases have been described, but most commonly are in conjunction with severe COVID-19 infections as well as pancreatic enzyme elevation. It has been demonstrated that patients with acute pancreatitis and coexistent COVID-19 infections have a significantly higher morbidity and mortality than those without acute pancreatitis. We describe a unique case of mild COVID-19 infection resulting in acute pancreatitis in the absence of lipase elevation.

Case Description/Methods: A 39-year-old patient with no significant past medical history, including no history of chronic pancreatitis or alcohol use disorder, presented with epigastric pain, loss of taste and smell, fever and dry cough. Vital signs were within normal limits. Laboratory findings were significant for positive COVID-19 testing. Liver function panel, calcium, triglyceride, and lipase levels were all unremarkable. Computed tomography of the abdomen was consistent with acute pancreatitis without evidence of gallstones and without pancreatic, intra or extrahepatic biliary dilatation. The patient underwent conservative management with bowel rest and intravenous fluids and was discharged without complications.

Discussion: This case introduces a rare presentation of acute pancreatitis without lipase elevation in setting of mild COVID-19 infection. It has been unclear whether lipase elevation in COVID-19 is due to direct pancreatic injury or viral-induced systemic inflammatory response causing multiorgan dysfunction. Our case may indicate that there is a direct impact on the pancreas by the SARS-CoV-2 virus, which has been postulated given the presence of ACE-2 receptors in the pancreas. This case also highlights the importance of suspecting pancreatitis in patients with mild COVID-19 infections that present with atypical symptoms such as epigastric pain, even without lipase elevation. Early identification in these cases may help to reduce progression and prevent worse outcomes.


Figure: Computed Tomography (CT) of the abdomen demonstrated mild peripancreatic inflammation at the level of the tail, with no clear pancreatic lesion and no loculated fluid collection. There was no calcified gallstone and no pancreatic ductal, intra or extrahepatic biliary dilatation.


Disclosures:
Brianna Hatch-Vallier indicated no relevant financial relationships.
Fadi Hawa indicated no relevant financial relationships.
Vijay Jarodiya indicated no relevant financial relationships.
Rebecca Daniel indicated no relevant financial relationships.


Brianna L. Hatch-Vallier, DO¹, Fadi Hawa, MD², Vijay Jarodiya, MD¹, Rebecca Daniel, MD, DipABLM³. P2183 - A Rare Presentation of Acute Pancreatitis in Mild Coronavirus Disease 2019 Infection, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.