S1595 A Curious Case of COVID-19-Induced Acute Severe Pancreatitis

Abstract

Introduction: The COVID-19 virus causes a wide range of lung diseases. It has also been proven to affect other organ systems. Acute pancreatitis is defined as inflammation of the pancreas and has varied etiologies. SARS-CoV2 affects the pancreas by direct binding to ACE2 receptors and stimulation of an inflammatory cytokine storm. Here, we present a rare case of acute pancreatitis induced by COVID-19 in an healthy individual. Case Description/Methods: 35 y.o male with no medical history presented with altered mental status. He was noted to be hypothermic, hypotensive, and tachypneic. Labs revealed, elevated anion gap metabolic acidosis, leukocytosis, ketonuria with elevated blood glucose of 1056mg/dL. Treatment for DKA was started with insulin drip and IV fluids. Patient tested positive for COVID-19, however had no respiratory symptoms. HbA1c was 18. On the 4th day of admission, he developed emesis and epigastric abdominal pain. A CT abdomen revealed features of acute pancreatitis, no evidence of necrosis or fluid collection. Lipase was elevated to 1399. He began spiking intermittent fevers, was initiated on systemic antibiotic therapy. A workup for various etiologies of pancreatitis was performed. A thorough work-up and medication reconciliation ruled out many etiologies of pancreatitis, including alcohol, medications, triglycerides, biliary, and autoimmune pathologies. Abdominal pain continued with development of abdominal distention, therefore, TPN was initiated. Inflammatory markers were elevated. Patient was managed with bowel rest, IV fluids and pain control. A repeat CT abdomen showed persistent ongoing inflammation in the abdomen secondary to pancreatitis and ongoing retroperitoneal fluid. This patient presented with DKA, new onset diabetes mellitus and development of acute pancreatitis. While common causes were ruled out, one diagnosis to consider is COVID-19 induced acute pancreatitis. The absence of other causes, this remains a diagnosis of exclusion. Discussion: Etiologies of acute pancreatitis include alcohol use and gallstone disease. Diagnosis requires 2/3: abdominal pain, imaging of pancreatic inflammation, and lipase elevation. Several viruses have been implicated in the etiology of acute pancreatitis, SARS-CoV-2 also has its significance. Understanding of clinical manifestations of COVID-19 continues to evolve, this case demonstrates that SARS-CoV-2 can precipitate pancreatitis. It is important that clinicians remain cognizant of COVID-19 being a cause for acute pancreatitis.