CT-guided Percutaneous Drainage Research Articles

Hounsfield Units as an Independent Predictor of Failed Percutaneous Drainage of Spinal Tuberculosis Paraspinal Abscess Under Computed Tomography Guidance.

To investigate the value of Hounsfield units (HUs) as an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under computed tomography (CT) guidance. A retrospective analysis was conducted on 61 patients who underwent CT-guided percutaneous drainage for spinal tuberculosis paraspinal abscess between October 2017 and October 2020. Preoperative CT scans were used to measure the HUs of the abscess. Patients were categorized into successful drainage (n = 49) and failed drainage (n = 12) groups. Statistical analysis involved independent sample t-tests and chi-square tests to compare between the 2 groups. Binary logistic regression was performed to identify independent predictive factors for drainage failure. Receiver operating characteristic (ROC) curves were employed to ascertain risk factor thresholds and diagnostic performance. Among the patients, 49 experienced successful drainage while 12 faced drainage failure. The mean HUs of abscesses in the failed drainage group were significantly higher than those in the successful drainage group (p < 0.001). ROC analysis revealed an area under the curve of 0.897 (95% confidence interval, 0.808-0.986) for predicting drainage failure based on HUs. The optimal HU cutoff value for predicting drainage failure was 22.3, with a sensitivity of 91.7% and specificity of 69.4%. HUs are an independent predictor of failed percutaneous drainage of spinal tuberculosis paraspinal abscess under CT guidance. The HU value of 22.3 can be used as an initial screening threshold for predicting the success or failure of drainage.

Evaluation of viscosities of typical drainage fluids to promote more evidence-based catheter size selection

Percutaneous drainage is a first-line therapy for abscesses and other fluid collections. However, experimental data on the viscosity of body fluids are scarce. This study analyses the apparent viscosity of serous, purulent and biliary fluids to provide reference data for the evaluation of drainage catheters. Serous, purulent and biliary fluid samples were collected during routine drainage procedures. In a first setup, the apparent kinematic viscosity of 50 fluid samples was measured using an Ubbelohde viscometer. In a second setup, the apparent dynamic viscosity of 20 fluid samples obtained during CT-guided percutaneous drainage was measured using an in-house designed capillary extrusion experiment. The median apparent kinematic viscosity was 0.96 mm2/s (IQR 0.90–1.15 mm2/s) for serous samples, 0.98 mm2/s (IQR 0.97–0.99 mm2/s) for purulent samples and 2.77 mm2/s (IQR 1.75–3.70 mm2/s) for biliary samples. The median apparent dynamic viscosity was 1.63 mPa*s (IQR 1.27–2.09 mPa*s) for serous samples, 2.45 mPa*s (IQR 1.69–3.22 mPa*s) for purulent samples and 3.50 mPa*s (IQR 2.81–3.90 mPa*s) for biliary samples (all differences p < 0.01). Relative to water, dynamic viscosities were increased by a factor of 1.36 for serous fluids, 2.26 for purulent fluids, and 4.03 for biliary fluids. Serous fluids have apparent viscosities similar to water, but biliary and purulent fluids are more viscous. These data can be used as a reference when selecting the drainage catheter size, with 8F catheters being appropriate for most percutaneous drainage cases.

Significance of Postprocedural Contrast Medium Injection after CT-Guided Abscess Drainage.

The aim was to evaluate the additive clinical value of an additional post-procedural control-scan after CT-guided percutaneous abscess drainage (PAD) placement with contrast medium (CM) via the newly placed drain. All CT-guided PADs during a 33-month period were retrospectively analyzed. We analyzed two subgroups, containing patients with and without surgery before intervention. Additionally, radiological records were reevaluated, concerning severe inflammatory response syndrome (SIRS) during the intervention. A total of 499 drainages were placed under CT-guidance in 352 patients. A total of 197 drainages were flushed with CM directly after the intervention, and 51 (26%) showed an additional significant finding. An immediate change of therapy was found in 19 cases (9%). The subgroup that underwent surgery (120 CM-drainages; 32 (27%) additional findings; 13 (11%) immediate changes of therapy) showed no statistically significant difference compared to the subgroup without surgery (77 CM-drainages; 19 (25%) additional findings; 5 (6%) immediate changes of therapy). SIRS occurred in 2 of the 197 flushed drainages (1%) after CM application. An additional scan with CM injection via the newly placed drain revealed clinically significant additional information in almost 26% of the drainages reviewed in this study. In 9% of the cases this information led to an immediate change of therapy. Risks for SIRS are low.

Comparing Outcomes of CT-Guided Percutaneous Pericardial Drainage with Surgical Pericardial Window in Patients with Symptomatic Pericardial Effusions

To compare short-term outcomes of CT-guided percutaneous pericardial drainage (PPD) versus subxiphoid surgical pericardial window (PW) drainage and analyze the risk factors associated with their outcomes. A retrospective chart review of patients who underwent either percutaneous drainage with drainage catheter placement or PW with surgical drain placement for symptomatic pericardial effusion between January 1, 2006 and August 31, 2016 was performed after institutional review board approval (decision number 16-783). The primary objective was to test for associations between the short-term (≤30 days post procedure) complication and recurrence rates in patients with symptomatic pericardial effusions. The secondary objectives were to test for associations between short-term complications with changes in vital signs. Of the 257 procedures included in the final analysis, 142 were in the percutaneous drainage group. Short-term complication rate was significantly greater (p < 0.001) in patients undergoing PW, 17% (19/114), as compared with PPD, 2% (3/142). The estimated odds of having complications in the PW cohort was 9 times greater than the percutaneous drainage cohort (OR=9.3, 95% CI: 2.7-32.3). No significant difference was observed between whether or not a patient experienced a short-term recurrence and any of the explanatory variables (patient demographics, imaging, and vital signs). CT-guided PPD is a safer alternative to surgical PW as it leads to fewer complications without a significant difference in recurrence rate of pericardial effusion.

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

IN THE EYE OF THE STORM: HYPERVIRULENT KLEBSIELLA PNEUMONIAE

Comparison between Percutaneous Drainage vs Operative Intervention in Treatment of Appendicular Abscess: A Retrospective Study

Aim: To evaluate the outcomes of percutaneous drainage and surgery in periappendiceal abscesses. Study design: A Retrospective study Place and Duration: This study was conducted at Jinnah Postgraduate Medical Centre Karachi Pakistan from January 2020 to December 2021. Methodology: For this study, we defined abscess as fluid collection adjacent to the appendix with 0-20 Hounsfield units (HU) attenuation on CT scan. Classification of Jeffrey, et al was used to grade abscesses. According to the classification patients with abscess or phlegmon, lesser than or equal to 3cm were represented in the grade 1 category. Grade 3 comprised those patients who had larger abscesses extending to the pelvic cavity. Patients of periappendiceal abscess aged above 16 years were enrolled for this study. The diagnosis was based on CT findings. The patient's discharge summary was used for confirmation. All the patients underwent two treatment options; Surgery or ultrasonography or CT-guided percutaneous drainage. Results: Out of 67 cases 44 (65.6%) cases underwent percutaneous drainage while 23 (34.3%) patients underwent surgery. Male participants were 37, 55.2% with a relative ratio of females (30, 44.7%). The mean symptoms onset was reported as 5 days ranging from 1-to 30 days. We observed that the percutaneous drainage group had 84.1% (37 cases) successful outcomes with a 15.9% (7 cases) failure ratio whereas only a single case of failure was observed by a surgery. Conclusion: Our results concluded that percutaneous drainage is effective for treating abscesses &gt;6cm with a low risk of recurrence. However, this procedure lengthens the hospital stay until the complete resolution of the abscess. Keywords: Abscess, Percutaneous drainage, Surgery

Is routine imaging necessary prior to percutaneous abscess catheter removal?

Routine management after abscess drainage includes CT or fluoroscopic imaging to assess for residual abscess cavity prior to catheter removal. It is unclear whether this practice is necessary in patients without residual infection signs and symptoms. To evaluate safety of abscess catheter removal without follow-up imaging in patients without residual clinical or laboratory signs of infection and catheter output < 10cc/day for 2 consecutive days. In this IRB-approved, HIPAA compliant, retrospective study, consecutive patients that underwent percutaneous CT-guided drainage of a single abdominal or pelvic abscess between 01/2015 and 12/2017 in a single tertiary academic institution with or without follow-up imaging prior to catheter removal were included. In our institution, catheters are routinely removed without imaging if there are no clinical (fever, pain) or laboratory (elevated WBC count) signs of infection and catheter output is < 10cc/day for 2 consecutive days. Patients' and abscess's characteristics, repeat imaging data, and need for re-interventions were obtained through medical records review. Statistical analysis was performed with Fisher's exact test for independent data and Student's t-test for comparison of group means. 310 consecutive patients (age 56 ± 16years, 48% female) were included in the study. In 265/310 (85%) patients, no routine follow-up imaging prior to catheter removal was obtained. In 2/265 (0.8%, 95% CI 0.02-0.27%) patients without routine pre-removal imaging, repeat abscess drainage was required 6 and 15days after catheter removal in patient with perforated appendicitis and after laparoscopic renal cyst decortication, respectively. No patients, 0/45 (0%, 95% CI 0-0.07), that underwent routine imaging without clinical or laboratory signs infection needed to undergo a repeat abscess drainage. There is a low rate (0.8%) of abscess recurrence if percutaneous abscess catheter is removed at the time cessation of drainage without routine imaging in clinically well patient.

Does computed tomography-guided percutaneous catheter drainage is effective for spinal tuberculous abscess: a midterm results.

Retrospective cohort study. To evaluate an effectiveness and report a midterm clinical outcome in pain and neurological status in spinal tuberculous abscess after treated by CT-guided percutaneous catheter drainage. Spinal tuberculosis is one of the destructive forms of tuberculosis infection, which can cause undesirable consequences. The gold standard of surgical treatment of spinal tuberculosis with tuberculous abscess is radical debridement, abscess drainage, and bone grafting of the defect via anterior approach. However, this treatment may lead to several serious complications. CT-guided percutaneous catheter drainage is an alternative procedure for this condition and may reduce the serious complications from standard surgical treatment. The medical record of the patients with spinal tuberculosis with tuberculous abscess who underwent CT-guided percutaneous catheter drainage (CT-guided PCD) from 2015 to 2021. The visual analog pain scale (VAS), Frankel grading scale, duration of drainage, amount of spinal tuberculous abscess, and complications were evaluated. Twenty-nine patients (mean age 44 years old) were included in the study. All patients were followed up for 24 to 72 months with an average of 36 months. Level involvements were mostly found in L1-L2 followed by L2-L3 and T12-L1 levels. A 14-Fr catheter was the mostly use followed by 16-Fr catheter. Amount of abscess drainage ranged from 110 to 2,490 ml (mean 599 ml). The drainage duration ranged from 6 to 42 days (mean 17 days). Additional surgery was performed in three patients due to subsequent mechanical instability developed despite successful drainage of abscess. At the last follow-up, VAS, Frankel grading scale were improved significantly in all patients without complications. CT-guided percutaneous catheter drainage is a safe and effective alternative procedure in the treatment of spinal tuberculous abscess patients with high success rate, less complications, and satisfied midterm outcomes.

Clinical Efficacy of CT-Guided Continuous Catheterization Drainage for Spinal Tuberculosis with Large Abscesses.

Objective This study aimed to determine the efficacy of computed tomography (CT)-guided local catheterization for the treatment of spinal tuberculosis (TB) with abscess. Methods Clinical data from 22 cases of lumbar TB with abscess receiving treatments from July 2015 to January 2021 were analyzed. Some patients (n = 11) underwent pure surgery (control group) and the others (n = 11) received CT-guided catheterization drainage. The operation and hospitalization time, erythrocyte sedimentation rate (ESR), visual analog scale (VAS), ASIA damage grade, and C-reactive protein (CRP) levels of both groups were compared. Results The operation time, intraoperative blood loss, and hospital stay of the observation group were significantly less than those of the control group (P < 0.05). As the differences in preoperative ESR, CRP, and VAS scores between both groups did not reach significance (P > 0.05), after treatments, the observation group had a lower level of ESR and CRP (P < 0.05); the postoperative VAS scores of the two groups decreased (P > 0.05). Before treatment, the control group comprised 2 cases of ASIA grade A, 1 case of B, 6 cases of C, and 2 cases of D with 3 patients having dyskinesia. After surgery, the motor function of the patients was improved, and there were 3 cases of ASIA D and 8 cases of E. Meanwhile, the preoperative observation group consisted of 9 cases of ASIA D and 2 cases of E. Due to CT-guided catheterization, all patients achieved clinical healing (ASIA E) when the lesions were significantly alleviated, and symptoms such as low back pain and lower extremity pain disappeared. Conclusion CT-guided percutaneous catheter drainage for continuous administration of drugs is effective treatment for spinal TB with abscess, when shortening the operation and hospitalization time and reducing intraoperative blood loss and erythrocyte sedimentation rate. It is worthy of popularization and application.

CT Texture analysis and CT scores for characterization of fluid collections

BackgroundTexture analysis derived from Computed tomography (CT) might be able to better characterize fluid collections undergoing CT-guided percutaneous drainage treatment. The present study tested, whether texture analysis can reflect microbiology results in fluid collections suspicious for septic focus.MethodsOverall, 320 patients with 402 fluid collections were included into this retrospective study. All fluid collections underwent CT-guided drainage treatment and were microbiologically evaluated. Clinically, serologically parameters and conventional imaging findings as well as textures features were included into the analysis. A new CT score was calculated based upon imaging features alone. Established CT scores were used as a reference standard.ResultsThe present score achieved a sensitivity of 0.78, a specificity of 0.69, area under curve (AUC 0.82). The present score and the score by Gnannt et al. (AUC 0.81) were both statistically better than the score by Radosa et al. (AUC 0.75). Several texture features were statistically significant between infected fluid collections and sterile fluid collections, but these features were not significantly better compared with conventional imaging findings.ConclusionsTexture analysis is not superior to conventional imaging findings for characterizing fluid collections. A novel score was calculated based upon imaging parameters alone with similar diagnostic accuracy compared to established scores using imaging and clinical features.

S1745 Immune-Mediated Colitis Complicated by Peri-Colonic Abscess and Colonic Perforation Managed by Percutaneous CT-Guided Drainage

Introduction: Immune checkpoint inhibitors have revolutionized the field of oncology, but they are associated with many gastrointestinal adverse effects. Management includes high-dose steroids but may require a second-line immunosuppressant. However, severe cases can be refractory to standard treatment. Case Description/Methods: We present a case of a 73-year-old male with metastatic renal cell carcinoma status post left nephrectomy on nivolumab who presented to an outside institution with painless hematochezia. Colonoscopy demonstrated pan-diverticulosis with ascending and transverse colitis with ulcerations, however biopsies were negative for cytomegalovirus DNA. Extended enteric pathogen stool and Clostridium difficile stool studies were negative. These studies lowered the suspicion of infectious colitis and suggested the diagnosis of immunotherapy-induced colitis. Therefore, he was initiated on steroids. During the hospitalization, patient continued to have copious amounts of diarrhea, which led to hypovolemic shock and vasopressor support. The diarrhea subsequently turned into large volumes of hematochezia and the patient required multiple transfusions for his anemia. He was then transferred to our institution for further workup of immunotherapy-induced colitis refractory to steroid therapy. At our institution, repeat colonoscopy demonstrated severe inflammation in the transverse and descending colon, characterized by deep ulcerations (Fig. 1A and B). Hospital course was complicated by uncontrolled duodenal ulcer hemorrhage despite epinephrine injection, which necessitated embolization of the gastroduodenal artery. Subsequent computed tomography (CT) angiography showed perforated descending colonic diverticulitis and air collection adjacent to the descending colon. Due to his multiple comorbidities, the risks of surgery outweighed the benefits. He underwent CT-guided aspiration and drain placement for the fluid collection. Due to continued bleeding, another colonoscopy was repeated, but was aborted due to presence of medium sized tear (Fig. 1C). The patient continued to decompensate throughout a prolonged hospitalization and later passed away. Discussion: To our knowledge, this is the first case of immune checkpoint inhibitor colitis that led to concomitant colonic perforation and peri-colonic abscess. Our case highlights a rare but potential fatal complication associated with immune check point inhibitors.Figure 1.: ∼7cm pedunculated polyp in the ascending colon.

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease.

BackgroundIn patients with active Crohn’s disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD.MethodsA multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1–14 days, 15–30 days and more than 30 days) for comparison of outcomes.ResultsThe cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24–44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6–15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042).ConclusionSmoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.

Reducing Ionizing Radiation Dose during Ct-Guided Percutaneous Drainage of Pelvic Collections and Abscesses Using Iterative Reconstruction Algorithms: Preliminary Experience

Reducing Ionizing Radiation Dose during Ct-Guided Percutaneous Drainage of Pelvic Collections and Abscesses Using Iterative Reconstruction Algorithms: Preliminary Experience

Initial Experience of Operator-controlled Gating Technique Under Free Breathing During CT-guided Percutaneous Drainage of Postoperative Deep Upper Abdominal Fluid Collections

Interventional drainage is the standard treatment for patients with postoperative abscesses and clinically relevant postoperative pancreatic fistulae. It is preferred over repeat surgery because the latter is associated with high morbidity and mortality rates.1–3

Annals for Educators - June 2021.

Annals for Educators - June 2021.

Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver

BackgroundA chronic expanding hematoma (CEH) enlarges as a result of slight bleeding over several months, and the tissue shows a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue. This report presents a case of a subcapsular hepatic CEH that was treated with transarterial embolization (TAE) and hepatectomy.Case presentationA 56-year-old man presented with vomiting and right-sided abdominal pain. Plain abdominal computed tomography (CT) showed a high-density area of fluid collection beneath the capsule of the right hepatic lobe, which was diagnosed as a hematoma. From its anatomical position on the CT images, a subcapsular hepatic hematoma was diagnosed. Though conservative therapy was provided, CT-guided percutaneous drainage and TAE were performed due to worsening symptom. Because the patient's abdominal symptoms re-appeared, extended right segmentectomy including the hematoma was performed. In the resected specimen, the hematoma was located beneath the capsule of the right hepatic lobe, and it was displacing the hepatic parenchyma. Microscopic examination showed a thick fibrous capsule around the hematoma, peripheral lymphocyte and plasmacyte invasion, and aggregations of histiocytes containing phagocytosed hemosiderin.ConclusionsAnatomically, this was a case of a subcapsular hepatic hematoma, and pathologically it was shown to be a CEH. Complete surgical resection was effective treatment for this CEH.

CT-guided Percutaneous Drainage of Intra-spinal Haematoma as an Alternative to Surgical Evacuation.

CT-guided Percutaneous Drainage of Intra-spinal Haematoma as an Alternative to Surgical Evacuation.

Retroperitoneoscopic Drainage of Psoas Abscess: A Systematic Review

Psoas abscess is a relatively rare clinical condition that can occur worldwide, is difficult to diagnose, and has a severe clinical course. Conventional treatment ranges from antibiotic therapy alone to computed tomography (CT)-guided and/or open surgical drainage. Retroperitoneoscopic drainage represents a minimally invasive and potentially definitive therapeutic option. A systematic review of the literature on minimally invasive extraperitoneal access for drainage of psoas abscess was conducted through PUBMED, EMBASE, and COCHRANE databases, according to the PRISMA statement guidelines. We considered only studies in English and with a full text. The quality of all selected articles was assessed for the risk of methodological bias. Additional literature sources were used to put into context the indications and limits of retroperitoneoscopic drainage. Seven papers published between 2004 and 2020, including a total of 56 patients, met the eligibility criteria and were included in the qualitative analysis. Causative agents of psoas abscess included Mycobacterium tuberculosis, Klebsiella pneumoniae, Enterobacter aerogenes, Staphylococcus aureus, and Streptococcus spp. Tuberculous abscess was more common than pyogenic abscess (92.8% vs. 7.2%). Main clinical findings were back pain (76.8%) and fever (53.6%). All patients were preoperatively evaluated by CT or magnetic resonance imaging. Only 4 patients (7.1%) had previously undergone CT-guided percutaneous drainage. Retroperitoneoscopic drainage was combined with antibiotic therapy in all cases. No Clavien-Dindo grade >3 complications occurred, and there was no 30-day postoperative mortality. The recurrence rate was 1.8% at a mean follow-up of 21 months. Retroperitoneoscopic surgical drainage is a safe and effective approach for the treatment of psoas abscess.

CT-Guided Percutaneous Drainage of Pneumoperitoneum Presenting as Acute Abdomen

PurposeTo evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen. Materials and MethodsIn this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51–85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0–10). Patient records were reviewed to determine PD-related adverse events and median drain duration. ResultsThe median pneumoperitoneum volume was 891.1 (127.7–3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1–3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis. ConclusionsPD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.

S1436 Outcome of the Use of Corticosteroids for Treatment of Autoimmune Pancreatitis (AIP) in a COVID-19 Patient

INTRODUCTION: Autoimmune Pancreatitis (AIP) is a steroid-responsive disease of the pancreas. Due to poor outcomes in severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV) outbreaks, the World Health Organization (WHO) advises against the use of corticosteroids in the treatment of 2019 Coronavirus Disease (COVID-19) except if steroid therapy is required for coexisting illness. We present a case of uncontrolled AIP which was treated with high dose steroids while the patient was hospitalized with COVID-19. CASE DESCRIPTION/METHODS: A 53-year-old male was hospitalized with COVID-19 and uncontrolled AIP. The patient had elevated IgG4 levels and negative work up for other etiology of pancreatitis in the past and was already taking prednisone 40 mg daily due to a recent AIP exacerbation. On physical exam, temperature of 101 F, heart rate 101 beats/minute, respiratory rate 20 breaths/minute while blood pressure was normal. Tenderness in the epigastric region was noted. Labs showed Hct 35.8%, WBC 12.32 thousand/uL, BUN 9 mg/dL, lipase 530 u/L and normal LFTs. CT abdomen showed severe necrotizing pancreatitis with infected necrosis (multiloculated collections of gas and fluid) (Image 1). Chest imaging showed bibasilar infiltrates consistent with COVID-19 pneumonia (Image 2). Patient was continued on steroids, started on meropenem, and supportive treatment for COVID-19. Due to persistent abdominal pain and inability to tolerate oral intake, the patient underwent CT-guided percutaneous drainage of the necrotic collection. Azathioprine (AZA) was added to treatment regimen due to uncontrolled AIP despite steroid therapy. Patient recovered clinically without need for oxygen supplementation or further complication from COVID-19. He was discharged from the hospital with a short antibiotic course, a prescription to continue AZA and prednisone 40 mg with plan to taper dose by 5 mg per week. He returned home to continue quarantine which he completed without problems. DISCUSSION: Despite having multiple risk factors associated with poor outcomes in COVID-19 (age greater than 45 years, male gender, comorbidity due to uncontrolled AIP and immunosupression with steroid treatment), our patient experienced complete resolution of the illness with supportive measures. Our case supports current recommendations advocating steroid therapy for co-existing diseases in patients with COVID-19.Figure 1.: Image 1. CT scan abdomen shows multiloculated ill-defined of herterogeneous consistency as well as presence of gas pockets in the pancreatic and peri-pancreatic tissues, consistent with infected pancreatic necrotic collection in (A) and (B).Figure 2.: Image 2: Bibasilar lower lung infiltrates seen on CT scan chest (A) and Chest X-ray PA view (B), consistent with COVID-19 pneumonia.