S1422 COVID-19-Associated Pancreatitis: It's Not All About the Lungs

Abstract

INTRODUCTION: Acute pancreatitis resulting from COVID-19 infection has rarely been reported in the literature. We describe a case series of two patients with COVID-19 infection who presented with gastrointestinal (GI) symptoms and COVID-19 associated acute pancreatitis. CASE DESCRIPTION/METHODS: CASE 1 An 18-year-old hispanic male presented to the hospital with acute onset of epigastric pain and vomiting. Blood tests on admission: leukocytosis 10.6K, lymphopenia 5.2%, and elevated lipase of 9916 unit/L. A CT scan of abdomen and pelvis showed enlargement of the pancreas with surrounding fat stranding, consistent with acute interstitial pancreatitis. He had persistent fevers with negative septic work up but confirmed COVID-19 infection. Other causes of acute pancreatitis were ruled out. He was diagnosed with COVID-19 related pancreatitis, and on a follow-up outpatient he had resolution of pancreatitis. CASE 2 A 66-year-old white male presented to the hospital with fever, shortness of breath, vomiting, and watery diarrhea. Laboratory tests on admission showed lymphopenia and elevated D-dimer of 287 ng/ml. CT scan of the chest showed bilateral patchy ground-glass opacities (Figure 1). COVID-19 RT-PCR nasopharyngeal swabs testing were negative four times. However, a stool sample was positive for COVID-19 RT-PCR. He clinically improved and was discharged home. Unfortunately, he was readmitted for abdominal pain and obstipation. His abdomen was distended with diffuse tenderness. Laboratory studies showed an elevated lipase of 9542 unit/L and amylase of 796 unit/L. Abdominal x-ray showed distended loops of bowels, suggesting ileus (Figure 2). Ultrasound of the abdomen showed ascites and non obstructive IVC thrombus. A CT scan of the pancreas showed diffuse peripancreatic edema, consistent with acute pancreatitis (Figure 3). He was started on therapeutic Lovenox, tolerated diet and was discharged home. DISCUSSION: COVID-19, is a novel virus that has caused a pandemic since it was first reported in Wuhan, China, in December 2019. Although respiratory symptoms are common presenting symptoms, more recent literature described patients presenting with GI symptoms. However, patients rarely can develop COVID-19 associated pancreatitis. Pancreatic injury can manifest as a spectrum ranging from an asymptomatic elevation of amylase and lipase to severe acute pancreatitis. Theories including cytokine response and susceptibility to ACE-2 receptor for COVID-19 have been proposed as possible mechanisms for acute pancreatitis.Figure 1.: CT chest findings.Figure 2.: Abdominal xray findings.Figure 3.: CT pancreas findings.