S1573 Case Report and Literature Review of Acute Pancreatitis in COVID-19 Patient

Abstract

INTRODUCTION: Recently subset of patients with COVID-19 has been presenting with complication of acute pancreatitis (AP). Although exact mechanism of how SARS-CoV-2 causes AP is unclear but different mechanism have been hypothesized. CASE DESCRIPTION/METHODS: We are presenting two cases. First case of 94 year old female who presented with nausea, vomiting, diarrhea, abdominal pain, weakness for 5 days. In the ED she was found hypoxic with SPO2 88% on room air. COVID-19 test result was positive. Blood investigations (Table 1) showed normal LFT and triglyceride, lipase level was high1846. CT abdomen showed AP with trace fluid collection. She was diagnosed with AP in the setting of acute COVID-19 infection and was treated supportively with good response. In second case of 58 year old female who was recently tested COVID-19 positive 2 weeks ago presented with abdominal pain, nausea and nonbilious vomiting since 2 weeks with poor oral intake. In the ED she was found to be afebrile, hypotensive with B.P of 97/81mmHg. Blood investigations showed (Table 1) high creatinine 8.1, high BUN 66, high lipase 685, high amylase 173, normal triglyceride. CT abdomen showed AP without any fluid collection. Diagnosis of AP in the setting of COVID-19 with renal failure was made after ruling out other causes and patient was treated supportively with intravenous fluids. Patient required dialysis for worsening renal function and uremia induced encephalopathy. She subsequently improved was discharged on long term dialysis. DISCUSSION: In both cases all the causes of AP were ruled out, making the diagnosis of COVID-19 induced AP more likely. To further evaluate this topic, we conducted an extensive literature search which resulted in identifying total of 6 published case studies (Table 2) with mean age of 50.5 years who were diagnosed with AP due to COVID-19 infection. It has been hypothesized that SARS-CoV-2 causes AP either due to its direct cytopathic effect by attacking ACE-2 receptors on pancreas or due to dysregulated immune response or cytokine storm leading to multi organ failure.Table 1.: Laboratory findings of cases on admissionTable 2.: Published Studies in the Literature (Acute Pancreatitis complication in COVID-19 infection)