Pancreatitis in Pediatric Patients With COVID-19

Samies, Nicole L.; Yarbrough, April; Boppana, Suresh B.

doi:10.1093/jpids/piaa125

Cited by 35 publications

(40 citation statements)

References 5 publications

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“…All cases were SARS CoV-2 RT-PCR positive. 36 The association between AP and SARS-CoV-2 is not well understood. Viral infections, including the coronavirus family, account for 10% of idiopathic AP.…”

Section: Discussionmentioning

confidence: 99%

Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis

Abbas¹,

Törnhage²

2021

IMCRJ

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Introduction Spread of the novel coronavirus SARS-CoV-2, since at least December 2019, has caused a pandemic. SARS-CoV-2 causes the disease COVID-19, which can affect several human organs. Abdominal pain is one of the known symptoms, but little is known about acute pancreatitis as a complication. As well, knowledge about viral transmission in families is limited. This case report describes MIS-C and acalculous acute pancreatitis in a child who was a member of a family in which four of five members had COVID-19. Case Report A previously healthy family was infected by SARS-CoV-2 from an unknown source. The 13-year-old daughter was infected by SARS-CoV-2 and symptomatic during two periods, with an asymptomatic interval in-between. During the first period, she had transient and mild upper respiratory symptoms which was followed four weeks later by a secondary severe illness. At that point, there was inflammation in multiple organs and signs of Multisystem Inflammatory Syndrome in Children (MIS-C) and a Kawasaki-like disease with skin rash, scalded skin in hands and conjunctivitis. Myocarditis, bronchopneumonia, pancreatitis, and hepatopathy without encephalopathy were noted. She required assisted ventilation for 5 days. There were laboratory signs of disseminated intravascular coagulopathy. The multisystem inflammation was treated with intravenous immunoglobulin (IVIG) once a day for four days and immunotherapy (high dose methylprednisolone (IV) once a day, for 12 days, then tapered over 4 weeks, anakinra (IV) four times daily for 12 days), low molecular weight heparin for 22 days and salicylates for 6 weeks leading to full restoration of health. The two brothers and mother in the family had mild to moderate COVID-19 infections. The father was not affected despite close contact with his children. The household transmission and clinical course and outcome are described. No further known COVID-19 infection occurred in the neighborhood during or immediately after the family cluster was discovered. Conclusion Penetrance and severity of COVID-19 can vary in family clusters. One adolescent showed a two-phase course with severe infection. This case report highlights MIS-C and acute pancreatitis as a complication associated with COVID-19 in children.

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Section: Discussionmentioning

confidence: 99%

Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis

Abbas¹,

Törnhage²

2021

IMCRJ

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“…The expression of ACE-2 receptors in islet cells and exocrine pancreas makes the pancreas one of the target organs for SARS-CoV-2. However, pancreatitis may develop with secondary immune-mediated damage during SARS-CoV-2 infection [ 37 ]. In our study, the pancreas was sampled in 21 cases, and focal acute pancreatitis was observed in 5% ( n = 1) of these cases.…”

Section: Discussionmentioning

confidence: 99%

Postmortem pathological changes in extrapulmonary organs in SARS-CoV-2 rt-PCR–positive cases: a single-center experience

Buğra¹,

Daş²,

Arslan³

et al. 2021

Ir J Med Sci

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Background Although the lung is seen as the main target organ affected by SARS-CoV-2, other organs are also damaged. Aim We aimed to determine the extrapulmonary findings of autopsies performed on cases with positive results with postmortem polymerase chain reaction test. Methods Pathological changes in extrapulmonary organs were examined with light microscopy. Results Heart, liver, spleen, kidney, pancreas, and central nervous system samples of these cases were evaluated. About 80% of the cases were men, and 20% were women. In the examination of heart, 28 of the cases had scar, 14 had acute myocardial infarction, 6 had acute and previous myocardial infarction findings, 2 had myocarditis, and 4 had interstitial mononuclear inflammatory cell infiltration. In the examination of the liver, portal inflammation was observed in 84 of the cases, steatosis in 54, centrilobular necrosis in 9, and capillary endotheliitis in the portal area in 7 of them. In the evaluation of the kidney, 37 cases had chronic pyelonephritis, 36 had tubular damage, 15 had tubulointerstitial necrosis, 16 had subcapsular microhemorrhage, 10 had capillary endothelitis, and 9 had a microvascular fibrin trombosis in their glomerular capillaries. In the central nervous system, 8 cases had infarction and liquefaction, 56 had perivascular petechial hemorrhage, 54 had acute hypoxic ischemic change, 3 had parenchymal microhemorrhage, and 52 had capillary endotheliitis. Conclusion Autopsies play an important role in systematically examining the damage caused by the virus in all organs in order to elucidate the pathogenesis of SARS-CoV-2 infection and contribute to the clinical management of infected patients.

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“…[ 13 ] USA 67 Male Acute hypoxic respiratory failure Acute onset epigastric abdominal discomfort and fever Epigastric tenderness Ground-glass opacity in the right lung apex Acute interstitial edematous pancreatitis with moderate peripancreatic stranding and edema L: 5295 U/L A: not reported Not done; only SARS-CoV-2 rapid test was positive 3 days after onset of abdominal pain and 2 days after hospitalization Liver chemistry tests, serum triglycerides, serum immunoglobulin G4 Alive Samies et al . [ 14 ] USA 15 Male Nasal congestion Anosmia, ageusia, vomiting, and abdominal pain Epigastric tenderness Scattered ground-glass opacities in bilateral lung fields Mild stranding around the head of the pancreas L: 233 U/L (4–39 U/L) A: not reported Positive 2 days after onset of abdominal pain and 1 day after hospitalization Liver chemistry tests, serum triglycerides. Alive Samies et al .…”

Section: Discussionmentioning

confidence: 99%

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

Fath

Mashaly²,

Elhadi

2021

J Med Case Reports

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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.

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Pancreatitis in Pediatric Patients With COVID-19

Cited by 35 publications

References 5 publications

Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis

Family Transmission of COVID-19 Including a Child with MIS-C and Acute Pancreatitis

Postmortem pathological changes in extrapulmonary organs in SARS-CoV-2 rt-PCR–positive cases: a single-center experience

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

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