Journal
TRANSLATIONAL GASTROENTEROLOGY AND HEPATOLOGY
Volume 6, Issue -, Pages -Publisher
AME PUBL CO
DOI: 10.21037/tgh-20-234
Keywords
Acute pancreatitis (AP); coronavirus disease-2019 (COVID-19); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); structural damage; case report
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This article reports a case of a COVID-19 patient with AP, hypothesizing a causal relationship with SARS-CoV-2 and suggesting that the presence of ACE 2 receptors in the pancreas or direct viral involvement may be related to AP in COVID-19. While there appears to be an association between diabetes and AP, data on the etiological role of diabetes in causing AP is limited.
The global pandemic of coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is predominantly a respiratory illness, but gastrointestinal (GT) manifestations of variable severity have been reported. In patients with COVID-19 pneumonia, observational studies have demonstrated the elevation of pancreatic enzymes as surrogate markers for pancreatic injury without evidence of acute pancreatitis (AP). We report a case of AP in a patient with COVID-19 with SARS-CoV-2 as possible etiological agent with imaging evidence of pancreatitis. We hypothesize a causal relationship of SARS-CoV-2 in this patient with an otherwise unexplained presentation of AP after excluding the common causes. We postulate that AP in COVID-19 could be related to the abundant expression of angiotensin converting enzyme 2 (ACE 2) receptors in the pancreas which serve as viral entry binding receptors for SARS-CoV-2 or due to direct viral involvement of the pancreas. Although there seems to be an association between diabetes and AP, the available data regarding the etiological role of diabetes in causing AP is very limited. We also propose that imaging studies such as computerized tomography (CT) scan of the abdomen should be considered in the diagnosis of AP in patients with COVID-19 infection to exclude the false positive amylase and lipase.
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