SARS-CoV-2 leading to acute pancreatitis: an unusual presentation

Abstract

During SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) pandemic, the etiologic agent of COVID-19, several studies described the involvement of other tissues besides the respiratory tract, such as the gastrointestinal tract. Angiotensin-converting enzyme-2, the functional virus host cell receptor expressed by organs and tissues, seems to have an important role in the pathophysiology and presentation of this disease. In pancreas, this receptor is expressed in both exocrine glands and islets, being a potential target for the virus and subsequent pancreatic injury. There are few articles reporting pancreatic injury in COVID-19 patients but most of them do not report acute pancreatitis. Diagnosing acute pancreatitis secondary to SARS-CoV-2 infection is challenging due to the need to rule out other etiologies as well the notable heterogeneous presentations. Herein we report the case of a patient with COVID-19 who developed severe acute pancreatitis.

Keywords: Acute pancreatitis; COVID-19; SARS-CoV-2.

Fig. 1

Axial image of chest CT scan showing multiple focal and bilateral ground-glass opacities, interlobular septal thickening and consolidation areas, which are typical pulmonary findings of COVID-19.

Fig. 2

CT scan demonstrating heterogeneously enhancing and edematous pancreas (red arrows).

Fig. 3

(a) MRCP showing evidence of acute pancreatitis with a diffusely enlarged pancreas (arrows) without focal lesions or gallstones. (b) MRCP showing no extrahepatic biliary duct dilatation (arrows) and homogeneous contrast in gallbladder (asterisk), demonstrating no evidence of choledocholithiasis or cholelithiasis.