P0066 - Atypical Presentation of COVID-19 Induced Pancreatitis

Raed Atiyat, MD¹, Hannah Beachwood, ², Samir Elias, MPH³, Amir Riaz, MD⁴, Yatinder Bains, MD¹, Theodore Dacosta, MD¹, Mehul Shah, MD^1
1Saint Michael's Medical Center, Newark, NJ; ²University of New England College of Osteopathic Medicine, Newark, NJ; ³St. George's University, Clifton, NJ; ⁴Cleveland Clinic Florida, Weston, FL

Introduction: Coronavirus 2019 is a viral infection that has the potential to affect multiple various organ systems. It is able to do so by attaching to the angiotensin-converting enzyme 2 (ACE-2) receptor via its spike S protein. ACE-2 is highly expressed in the pancreatic beta cells. A combination of direct cytotoxic injury from local viral invasion and indirect damage from an immune response may be at play. Overall morbidity and mortality are significantly higher in patients with acute pancreatitis who have positive PCR results for COVID-19 compared to those who were PCR negative, evidenced by higher Charlson Comorbidity Index and Bedside Index of Severity in Acute Pancreatitis scores.

Case Description/Methods: A 41 year-old male with no significant medical history presented to the emergency room (ER) with a 3 day history of fevers, chills, dyspnea, sharp epigastric pain radiating to the back, nausea, non-bloody non-bilious vomiting, watery diarrhea, loss of appetite and myalgia’s. Family history was unremarkable. He denied a history of tobacco, alcohol, or any illicit drug use. In addition, he denied any recent medication use, steroids, infections, trauma, surgeries, or autoimmune diseases. Upon arrival he was hemodynamically stable. Physical exam was notable for epigastric discomfort, and hypoactive bowel sounds. Laboratory studies were significant for Lipase 1250 U/L, AST 98 U/L, ALT 65 U/L ALP 55 U/L, and total bilirubin 0.7 mg/dL. The lipid profile was unremarkable. He was found to be Covid-19 PCR positive, as well as rapid influenza B positive. Additionally, ferritin 959 ng/mL, LDH 546 U/L, and d-dimer 991 ng/ml were elevated. CT abdomen and pelvis with oral contrast showed peripheral opacities in lower lung fields. No acute changes were noted in the pancreas, liver, and biliary system. Abdominal ultrasound revealed no significant biliary duct dilation. Patient was subsequently made nil per mouth, started on fluid resuscitated, Decadron, remdesivir, Heparin drip, and oseltamivir. GI symptoms resolved after 2 days of treatment.

Discussion: We propose that Covid-19 induced pancreatitis be included in the differential diagnosis in patients with gastrointestinal manifestations as it increases the likelihood of early diagnosis and aiding in early management. Misdiagnosis can result in mismanagement and potential harm. Also a need to raise suspicion of covid-19 infection in atypical unexplained abdominal pain, it has a potential role in reduction of transmission to other individuals.


Disclosures:
Raed Atiyat indicated no relevant financial relationships.
Hannah Beachwood indicated no relevant financial relationships.
Samir Elias indicated no relevant financial relationships.
Amir Riaz indicated no relevant financial relationships.
Yatinder Bains indicated no relevant financial relationships.
Theodore Dacosta indicated no relevant financial relationships.
Mehul Shah indicated no relevant financial relationships.


Raed Atiyat, MD¹, Hannah Beachwood, ², Samir Elias, MPH³, Amir Riaz, MD⁴, Yatinder Bains, MD¹, Theodore Dacosta, MD¹, Mehul Shah, MD¹. P0066 - Atypical Presentation of COVID-19 Induced Pancreatitis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.