S1575 A Case of Acute Pancreatitis Associated With the Novel Severe Acute Respiratory Syndrome Coronavirus-2

Abstract

INTRODUCTION: Acute pancreatitis is a frequent cause of hospital admissions. The most common causes are gallstones and alcohol, while 10% are infectious. To our knowledge, we present the 4th case of acute pancreatitis caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV2). CASE DESCRIPTION/METHODS: A 60-year-old African American male with uncontrolled hypertension presented with weakness and nausea for one week. He denied alcohol use, herbal medications and reported non-compliance to his prescribed medications. Vitals: BP 188/98 mmHg, HR 110/min. Physical exam revealed epigastric tenderness. Labs were significant for positive SARS-CoV-2, T bili:0.3mg/dl, IGG:1145mg/dl, IGM: 77mg/dl, calcium:8.3mg/dl, triglyceride:440mg/dl, Lipase 4800U/L and D-Dimer 2418 ng/ml. Ultrasound abdomen was negative for gallstones.CT abdomen revealed peripancreatic fat stranding. He was started on intravenous hydration and oxygen supplementation. His abdominal pain resolved and he tolerated a normal solid diet. He had a prolonged hospital course due to increasing oxygen requirements. Repeat imaging revealed possible pancreatic pseudocyst formation. He was diagnosed with SARS-CoV-2 pancreatitis as a diagnosis of exclusion. DISCUSSION: SARS-CoV-2 typically presents with respiratory symptoms. As more data emerges, gastrointestinal symptoms (GI) are being reported which is believed to be caused by feco-oral transmission route. Studies show that SARS-CoV-2, uses Angiotensin converting enzyme -2 (ACE2), a viral receptor found in the intestinal epithelia, to enter host cells downregulating the expression of ACE2 leading to intestinal inflammation. 10% of acute pancreatitis cases are infectious, although the exact incidence of viral pancreatitis is unknown. Studies show viral pancreatitis as a consequence of direct destruction of the pancreatic acinar cells and we hypothesize that SARS-CoV-2 via binding to ACE2, uses a similar mechanism. Also, it is associated with the formation of microthrombi, which may impair microcirculation causing inflammation and ischemia of the pancreas.Earlier, patients were admitted primarily based on respiratory-related symptoms. This case brings to our attention the incidence of GI symptoms and possible complications associated with the virus. It shows the challenges associated with treatment of both, in which fluid overload with subsequent acute respiratory distress syndrome is a concern. This case serves to increase awareness of a possible association of the novel SARS-CoV-2 with pancreatitis.Figure 1.: CT Abdomen and pelvis showing peripancreatic fat stranding.Figure 2.: CT Angiography abdomen and pelvis showing peripancreatic fluid collection.