Severe COVID-19 infection linked to Acute pancreatitis: Case Reports
New Delhi: A team of doctors from the Max Super Specialty Hospital in Shalimar Bagh, New Delhi, led by V S Gaurav Narayan, reported two cases demonstrating a link between COVID-19 infection and acute pancreatitis.
According to the case reports published in the Journal of the Association of Physicians of India, SARS CoV-2 maybe an important etiological factor for acute pancreatitis.
The first cases of COVID-19 were reported in Wuhan, China in December 2019. By March 2020, it evolved into a global pandemic and prompted a worldwide lockdown. The gastrointestinal involvement in COVID-19 has been extensively studied and it has been noticed that there have been a few cases of acute pancreatitis associated with COVID-19. Acute Pancreatitis is defined as the inflammatory process of the pancreas and has the following diagnostic criteria: i) Upper Abdominal Pain ii) Elevated Serum Lipase and Amylase. The most common cause of Pancreatitis is alcohol use although viral infections have also been implicated. There may be a link between COVID-19 Infection and Acute Pancreatitis.
The first case was that of a 28-year-old male with no previous history of substance abuse, who presented with fever, cough, and difficulty in breathing for a period of five days. He tested positive for SARS-CoV-2 and was admitted to the ICU. On the third day, the patient developed severe upper abdominal pain that radiated to the back along with vomiting and stopped the passage of flatus and stool. Abdominal pain worsened and abdominal distension developed. CT scan revealed acute necrotizing pancreatitis and chest radiographs indicated a progressively worsening pneumonia. The patient also developed Acute Kidney Failure and metabolic acidosis and was scheduled for a Sustained Low-Efficiency Dialysis. However, shortly after initiating ventilatory support, the patient went into cardiac arrest and succumbed to death. Acute Respiratory Distress Syndrome and Sepsis were implicated as the cause of death.
The second case was that of a 45-year-old female who tested positive for SARS CoV-2 and was initially stable with a 97% Oxygen Saturation. On the second day, the patient developed hypoxia and CT scans revealed moderate lung involvement. On the fourth day, the patient developed severe upper abdominal pain that radiated to the upper back and stopped passing flatus and stool. CT scans revealed Acute Necrotising Pancreatitis. The patient was started on routine treatment and her condition gradually improved. She made a complete recovery and was discharged from the hospital within 10 days.
These two cases show that COVID-19 infection might be an etiological factor for acute pancreatitis.
"It would be prudent to consider acute pancreatitis as a possible diagnosis in COVID cases with abdominal pain and investigate accordingly in the hope of improving outcomes in these patients," the team of doctors proposed.
Case reports titled, "Acute Pancreatitis in Severe COVID Pnuemonia," is published in the Journal of the Association of Physicians of India.