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Introduction: The association between worse COVID-19 outcomes and diabetes has been well-established in the literature. However, with more cases of new-onset diabetes and pancreatitis being reported with or after COVID-19 infection, it poses the question if there is a causal relationship between them. Case Description: 31 y/o female with COVID-19 infection 4-6 weeks ago with moderate symptoms (not requiring hospital admission or monoclonal ab), presented to ED with bandlike epigastric pain radiating to back, which is worsened with food, associated with nausea, vomiting, polyuria, and fatigue. Workup showed lipase 232, AST 180, ALT 256. Blood glucose was 281 and HbA1c was 12. CT A/P showed post cholecystectomy status, normal pancreas with mesenteric adenitis. MRCP showed hepatic steatosis with trace fluid around the pancreas s/o inflammation, and no evidence of choledocholithiasis or biliary dilatation. She denied alcohol use and autoimmune workup for pancreatitis was unremarkable. Islet cell antibodies were negative. The patient improved with fluid resuscitation and was discharged home on insulin with plans to transition to oral agents outpatient. Discussion(s): Long COVID is defined as a range of conditions or symptoms in patients recovering from COVID-19, lasting beyond 4 weeks after infection. A retrospective cohort study showed increased new-onset diabetes incidence in patients after COVID-19. This was redemonstrated in a systematic review and meta-analysis that showed a 14.4% increased proportion of new diagnoses of diabetes in patients hospitalized with COVID-19. Possible pathophysiology that have been attributed to this include undiagnosed pre-existing diabetes, hyperglycemia secondary to acute illness and stress from increased inflammatory markers during the cytokine storm, the effect of viral infections on the pancreas, and concurrent steroid use in patients with severe respiratory disease. The binding of SARS-CoV-2 to ACE2 receptors is thought to the other mechanism by which COVID can cause pancreatitis and hyperglycemia. Study showed increased lipase and amylase levels in patients with COVID and the increase in serum levels was proportional to the severity of the disease. Patients who died due to COVID-19 were also found to have degeneration of the islet cells. While, several studies have showed new onset diabetes and pancreatitis during an active COVID infections, we need larger cohort studies to comment on its true association or causation, especially in patients with long COVID symptoms. As more cases of new onset diabetes and pancreatitis with COVID-19 are being reported, there may be a need for more frequent blood sugar monitoring during the recovery phase of COVID-19.Copyright © 2023
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SESSION TITLE: COVID-19 Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Several studies on COVID-19 have helped us better understand the dynamics of this viral illness. Initially considered to be a respiratory disease, research later showed that it was the initiation of an aggressive systemic inflammatory response including a prothrombotic state. Clinicians have used inflammatory markers such as D-dimer as an indicator for underlying thrombotic state. We present the case of a pulmonary embolism (PE) despite normal D-dimer levels. CASE PRESENTATION: A 73-year-old female with a past medical history of hypertension and recent hospitalization for COVID-19 pneumonia. D-dimer on initial admission was 150, patient was treated for COVID-19 pneumonia and discharged home on 2L of O2 via nasal cannula. She returned to the hospital 1 month later with complaints of palpitations. EKG on admission showed sinus tachycardia, the patient was found saturating at 98% on 2L of oxygen, unchanged from time of discharge, otherwise vitally stable. Patients’ wells score was calculated at 1.5 which pointed towards patients being low risk for PE, D-dimer measured at 645, was within normal limits when adjusted for age, indicating a low probability of VTE. Due to recent hospitalization and infection with COVID-19, CT Angiography was obtained and showed PE of the right main pulmonary artery extending into segmental right upper and lower lobe pulmonary arteries with no right ventricular strain. Patient was started on anticoagulation, and she was discharged home in stable condition. DISCUSSION: It is now well established that COVID 19 infection causes a hypercoagulable state, Initial recommendations for management of patients with Covid-19 included measurement of serial D-dimers throughout the course of illness. This recommendation has since changed. In our case, despite the rise in inflammatory marker, the age-adjusted value was within normal limits. In addition, Wells Score, which is used to predict DVT and PE, did not serve to be a reliable scoring system. CONCLUSIONS: Trending laboratory markers like D-dimers from previous admissions should be used as a valuable tool when post COVID disease is suspected. Any increase in D-dimer even if below the cutoff for age-adjusted D-dimer should be an indicator for further evaluation with imaging to rule out underlying clots. Reference #1: Logothetis CN, Weppelmann TA, Jordan A, et al. D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19. JAMA Netw Open. 2021;4(10):e2128802. doi:10.1001/jamanetworkopen.2021.28802 DISCLOSURES: No relevant relationships by Kevser Akyuz No relevant relationships by Hanan Hannoodee No relevant relationships by verisha khanam No relevant relationships by Zain Kulairi No relevant relationships by DANYAL TAHERI ABKOUH