S1674 Recurrent Acute Pancreatitis Following COVID-19 Vaccine – A Case Study

Abstract

Introduction: Vaccines are playing a major role in stopping the current deadly SARS CoV 2 Pandemic. mRNA based vaccines were used for the first time on a massive scale. These vaccines were approved by FDA under EUA. Due to hastened clinical trials, certain side effects of these vaccines could become evident in the post marketing phase. Pancreatitis was reported as a side effect to mRNA-based vaccine (1, 2). We present a case of acute recurrent pancreatitis after administration of Pfizer-BioNTech COVID-19 mRNA vaccine. Case Description/Methods: A 46 yr old Asian Indian male was seen for symptoms of upper abdominal pain, nausea and vomiting, that started 2 days after the first dose of Pfizer-BioNTech COVID-19 vaccine. The symptoms worsened leading to hospitalization with diagnosis of acute pancreatitis. He was taking lisinopril and hydrochlorothiazide. He drinks 2 beers weekly. The lipase was 648 U/L with normal LFTs. CT scan showed uncomplicated acute pancreatitis involving the distal body and tail of the pancreas with normal biliary anatomy. He was discharged after improvement with NPO, IV fluids and analgesics. He was advised to stop alcohol. The lipase was 45 U/L on the day of discharge. He did well until after the second dose of vaccine. He developed similar symptoms of upper abdominal pain about 2 days after the vaccine shot. His pain continued to worsen in a similar fashion as happened after the first dose of vaccine leading to hospitalization. Denied use of alcohol. His lipase was 1483 U/L. CT abdomen showed peripancreatic inflammatory changes consistent with pancreatitis with a 5 cm complex thick-walled pseudocyst or walled off necrosis given the internal debris (Fig. 1). IgG4 and triglycerides were normal. Patient was again kept NPO and treated with analgesics and IV fluids. Lisinopril and HCTZ were discontinued. Patient was discharged with amlodipine. His lipase was 233 U/L on the day of discharge. Discussion: mRNA based COVID-19 vaccine is the most important weapon to stop the current deadly pandemic. Our goal is to make medical community aware of pancreatitis being one of the possible emerging side effects to the vaccine.Figure 1.: CT abdomen showed peripancreatic inflammatory changes consistent with pancreatitis.