Rare presentation of acute pancreatitis in mild COVID-19.

Viral-induced pancreatitis has been well-defined; however, there are limited data regarding COVID-19 and pancreatitis. Most cases are commonly in conjunction with severe COVID-19 as well as lipase elevation. We describe a unique case of mild SARS-CoV-2 infection resulting in acute pancreatitis in the absence of lipase elevation. A 39-year-old patient with no medical history, presented with epigastric pain. Vital signs were unremarkable. Patient was positive for COVID-19. Liver function panel, calcium, triglyceride and lipase levels were all unremarkable. CT of the abdomen demonstrated acute pancreatitis without gallstones. Our case may indicate that pancreatic injury in SARS-CoV-2 infection is due to a direct impact on the pancreas by the virus, given the absence of lipase elevation and mild presentation. This case highlights the importance of suspecting pancreatitis in mild COVID-19 that present with atypical symptoms such as epigastric pain, even without lipase elevation.

Hepatic Steatosis Is Associated with Increased Disease Severity and Liver Injury in Coronavirus Disease-19.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. AIMS: To characterize the impact of HS on disease severity and liver injury in COVID-19. METHODS: We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. RESULTS: In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. CONCLUSIONS: HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.