Acute pancreatitis associated with severe acute respiratory syndrome coronavirus-2 infection: a case report and review of the literature

Abstract

Introduction We report a case of Severe acute respiratory syndrome coronavirus-2 infection with acute pancreatitis as the only presenting symptom. To the best of our knowledge, there are few case reports of the same presentation. Case presentation An otherwise healthy 44-year-old white male from Egypt presented to the hospital with severe epigastric pain and over ten attacks of nonprojectile vomiting (first, gastric content, then bilious). Acute pancreatitis was suspected and confirmed by serum amylase, serum lipase, and computed tomography scan that showed mild diffuse enlargement of the pancreas. The patient did not have any risk factor for acute pancreatitis, and extensive investigations did not reveal a clear etiology. Given a potential occupational exposure, a nasopharyngeal swab for polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was done, which was positive despite the absence of the typical symptoms of severe acute respiratory syndrome coronavirus 2 such as fever and respiratory symptoms. The patient was managed conservatively. For pancreatitis, he was kept nil per os for 2 days and received intravenous lactated Ringer’s (10 ml per kg per hour), nalbuphine, alpha chymotrypsin, omeprazole, and cyclizine lactate. For severe acute respiratory syndrome coronavirus 2, he received a 5-day course of intravenous azithromycin (500 mg per day). He improved quickly and was discharged by the fifth day. We know that abdominal pain is not a rare symptom of severe acute respiratory syndrome coronavirus 2, and we also know that elevated levels of serum amylase and lipase were reported in severe acute respiratory syndrome coronavirus-2 patients, especially those with severe symptoms. However, the association between severe acute respiratory syndrome coronavirus-2 infection and idiopathic acute pancreatitis is rare and has been reported only a few times. Conclusion We believe further studies should be conducted to determine the extent of pancreatic involvement in severe acute respiratory syndrome coronavirus-2 patients and the possible causality between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis. We reviewed the literature regarding the association between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis patients. Published data suggest that severe acute respiratory syndrome coronavirus 2 possibly could be a risk factor for acute pancreatitis.

COVID-19 Induced Acute Pancreatitis in a Malagasy Woman Patient: Case Report and Literature Review

“…The association between COVID-19 and AP had already been reported by many North African authors (2 cases in Egypt, 4 cases in Morocco, 6 cases in Algeria). 7 , 8 , 27 , 34 , 39 …”

“…The main viruses reported were cytomegalovirus, Epstein Barr virus, mumps, hepatitis A, B and E viruses, herpes simplex virus, varicella zona virus, coxsackie viruses, echo viruses and human immunodeficiency virus (HIV). 7 , 9 , 12 , 14 Recently, COVID-19 has been identified as a possible viral cause of AP. The mechanism of the relationship between pancreatitis and COVID-19 infection remains unknown and multifactorial.…”

“… 42 Several case reports on SARS-CoV-2 infection induced AP have been reported by numerous authors confirming this relationship between COVID-19 and AP. 1 , 7–36 The description of these numerous case reports of COVID-19 induced AP is reported in Table 2 .…”

“… 3 , 6 COVID-19 has been reported by a number of authors as a possible etiology of AP. 1 , 7–36 Although viral AP has been described in other infections, evidence of pancreatic involvement induced by SARS-CoV-2 infection remains limited. Clinicians involved in the management of AP should be aware of its existence in the context of COVID-19.…”

Experience of One-Time Surgical Treatment of Pancreonekrosis and Caesarian Section in a Pregnant Woman With Covid-19

“…Указанные изменения, в свою очередь, индуцируют развитие диффузного микроишемического поражения тканей и целого органа. Как указывают отдельные авторы, подобный патологический механизм ишемического повреждения не исключается и в поджелудочной железе [7,8].…”