P1138 - A Rare Manifestation of COVID-19 in the Abdomen: Acute Pancreatitis

Sidra Naz, MBBS¹, Vikash Jaiswal, MD², Abhinav Patel, MBBS³, Akash Jaiswal, MD⁴, Deblina Mukherjee, MBBS⁵, Dattatreya Mukherjee, MBBS⁶, Madeeha Subhan Waleed, MBBS⁷, Christine Zakhary, MD⁸, Sadia Yaqoob, MBBS⁹, Himanshu Jindal, MBBS^10
1University of Health Science, Lahore, Punjab, Pakistan; ²AMA School of Medicine, Jaunpur, Uttar Pradesh, India; ³Terna Medical College, Mumbai, Maharashtra, India; ⁴All India Institute of Medical Sciences, South Delhi, Delhi, India; ⁵St. George's University School of Medicine, New Jersey, NJ; ⁶Jinan University, P.R China, Kolkata, West Bengal, India; ⁷Ayub Medical College, Abbotabad, Northern Areas, Pakistan; ⁸Ain Shams General Hospital, Greator Cairo, As Suways, Egypt; ⁹Jinnah Medical and Dental College, Karachi, Sindh, Pakistan; ¹⁰Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, Tripura, India

Introduction: Coronavirus, a novel menace, is exacting terrible human toll and mass death till date. It was thought that COVID-19 primarily affects the respiratory system, but recent studies have reported gastrointestinal manifestations as well. However, the incidence of acute pancreatitis in the setting of COVID-19 is a rising debate due to unknown mechanisms, especially in the absence of any precipitating factors for pancreatitis

Case Description/Methods: An otherwise healthy 30-year-old female presented to the emergency department with pain in the lower abdomen radiating to the back, fever, cough, vomiting, diarrhea, and sore throat for the past seven to ten days. Her initial examination revealed a temperature of 100℉, a pulse rate of 85 beats /minute, blood pressure of 110/70 mmHg, respiratory rate of 20 breaths/minute, and oxygen saturation of 94% on room air. Her swab result for SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) came positive. Laboratory testing revealed a rise in serum lipase and serum lipase level. Her ultrasonography (USG) of the abdomen was suggestive of fatty liver changes (hyperechoic parenchymal echogenicity) and no gallstones. She was managed conservatively with intravenous fluid, analgesics and antibiotics for bacterial infection. Absence of any predisposing factor for pancreatitis in the setting of COVID led to the diagnosis of acute pancreatitis induced by COVID-19. Her contrast-enhanced computed tomography (CECT) of the abdomen also confirmed our suspicion.



Discussion: The rationale behind the development of acute pancreatitis in the presence of COVID-19 infection, with no past medical history and precipitating risk factor for pancreatitis, is suggestive of COVID-19 as a triggering factor. This case highlights the importance of pancreatic enzyme monitoring if patients have abdominal complications and without further delay, proper management can be set up if diagnosed early. Future complications such as chronic pancreatitis and pseudocyst formation can also be prevented if timely diagnosed.


Figure: On non enhanced images pancreas appear enlarged and hypodense with irregular margins.
Table 1: Metabolic panel of the patient

Parameter	Day 3	Day 5	Reference range
Serum lipase (IU/L)	283	626	8-78
Serum amylase (IU/L)	171	820	25-125
Prothrombin time (seconds)	19	12.1	Control: 12
Activated partial thromboplastin time (seconds)	36	28.1	Control: 28
Blood glucose (mg/dL)	91	-	70-140
Blood urea (mg/dL)	35	-	10-50
Serum creatinine (mg/dL)	0.8	-	0.6-1.4
Total bilirubin (mg/dL)	0.4	-	Up to 1.0
Alkaline phosphatase (IU/L)	122	-	30-120
Aspartate aminotransferase (IU/L)	24	-	Up to 40
Alanine aminotransferase (IU/L)	12	-	Up to 40
Serum Na+ (mmol/L)	143	-	135-147
Serum K+ (mmol/L)	4.6	-	3.5-5.4
Total leukocyte count (/mm3)	16,900	-	4,000-11,000
Total platelet count (/mm3)	289,000	-	150,000-450,000

Disclosures:
Sidra Naz indicated no relevant financial relationships.
Vikash Jaiswal indicated no relevant financial relationships.
Abhinav Patel indicated no relevant financial relationships.
Akash Jaiswal indicated no relevant financial relationships.
Deblina Mukherjee indicated no relevant financial relationships.
Dattatreya Mukherjee indicated no relevant financial relationships.
Madeeha Subhan Waleed indicated no relevant financial relationships.
Christine Zakhary indicated no relevant financial relationships.
Sadia Yaqoob indicated no relevant financial relationships.
Himanshu Jindal indicated no relevant financial relationships.


Sidra Naz, MBBS¹, Vikash Jaiswal, MD², Abhinav Patel, MBBS³, Akash Jaiswal, MD⁴, Deblina Mukherjee, MBBS⁵, Dattatreya Mukherjee, MBBS⁶, Madeeha Subhan Waleed, MBBS⁷, Christine Zakhary, MD⁸, Sadia Yaqoob, MBBS⁹, Himanshu Jindal, MBBS¹⁰. P1138 - A Rare Manifestation of COVID-19 in the Abdomen: Acute Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.