A case of roasted pancreas from COVID-19 infection

ABSTRACT

INTRODUCTION: Although respiratory tract manifestations are most commonly reported symptoms in COVID-19, gastrointestinal system (esophagus, liver, gallbladder, pancreas and colon) is also affected by SARS-CoV-2, on the basis that they express angiotensin-converting enzyme 2 (ACE 2) receptor, the major receptor of SARS-CoV-2. We present a case of a patient with acute pancreatitis with COVID-19 infection that developed on day 6 of admission requiring a prolonged stay despite a normal respiratory status. CASE DESCRIPTION/METHODS: 68 year old male with a past medical history of hypertension, diabetes, CKD stage 3 who was a nursing home resident that tested positive for COVID-19 and was sent to ED for abnormal laboratory values. His admission labs were significant for Creatinine 6.6, BUN 77, CRP 158, Ferritin 920 and D-dimer 1.61. His creatinine improved to baseline with hydration. On day 6 of admission, he started complaining of nausea and vomiting. CT abdomen and pelvis and MRCP showed peripancreatic inflammatory changes consistent with acute pancreatitis. No biliary ductal dilatation or choledocholithiasis was seen. Lipase was 2035 along with an increase in WBC to 15.3 from 6.6. Abdominal exam was benign. His respiratory status was normal. He was managed with bowel rest and iv hydration. Gradually symptoms of nausea and vomiting improved. Diet was advanced gradually and the patient was discharged on day 19. DISCUSSION: The most common digestive symptoms reported in COVID-19 are lack of appetite, diarrhea, vomiting and abdominal pain. This was an example of a patient that had a delayed onset of GI symptoms including pancreatitis, while having normal respiratory function. Fluid hydration must be done judiciously in these patients, keeping in mind their respiratory status as it is suspected that these patients can be easily harmed by excessive fluid administration. (Figure Presented).