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

Alves, Amanda Mandarino; Yvamoto, Erika Yuki; Marzinotto, Maira Andrade Nacimbem; Teixeira, Ana Cristina de Sá; Carrilho, Flair José

doi:10.1016/j.bjid.2020.08.011

Cited by 48 publications

(45 citation statements)

References 19 publications

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“…[42][43][44][45] Since the beginning of the pandemic, associations have been drawn between COVID-19 infection and pancreatic injury and pancreatitis. Case reports have detailed the development of clinical pancreatitis following COVID-19 infection, [46][47][48][49][50] and several studies have suggested that elevations in amylase and lipase may be a fairly common feature of infection. 51,52 As noted above in studies focused on the islet, data on whether ACE2 is enhanced or decreased in pancreatic exocrine cells are conflicting, with some datasets suggesting an increase in ACE2 expression in the exocrine pancreas 40,53,54 and others suggesting relative depletion among the exocrine cells.…”

Section: Effects On β Cells Due To Infection Of Surrounding Cellsmentioning

confidence: 99%

Not so sweet and simple: impacts of SARS-CoV-2 on the β cell

Ibrahim

Monaco

Sims

2021

Islets

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The link between COVID-19 infection and diabetes has been explored in several studies since the start of the pandemic, with associations between comorbid diabetes and poorer prognosis in patients infected with the virus and reports of diabetic ketoacidosis occurring with COVID-19 infection. As such, significant interest has been generated surrounding mechanisms by which the virus may exert effects on the pancreatic β cells. In this review, we consider possible routes by which SARS-CoV-2 may impact β cells. Specifically, we outline data that either support or argue against the idea of direct infection and injury of β cells by SARS-CoV-2. We also discuss β cell damage due to a "bystander" effect in which infection with the virus leads to damage to surrounding tissues that are essential for β cell survival and function, such as the pancreatic microvasculature and exocrine tissue. Studies elucidating the provocation of a cytokine storm following COVID-19 infection and potential impacts of systemic inflammation and increases in insulin resistance on β cells are also reviewed. Finally, we summarize the existing clinical data surrounding diabetes incidence since the start of the COVID-19 pandemic.

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Section: Effects On β Cells Due To Infection Of Surrounding Cellsmentioning

confidence: 99%

Not so sweet and simple: impacts of SARS-CoV-2 on the β cell

Ibrahim

Monaco

Sims

2021

Islets

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“…There are few reported cases where inflammation of the ectopic tissue was identified either in isolation 9 or simultaneously 10 with inflammation of the anatomical pancreas. During the COVID-19 pandemic, we have also seen cases of SARS-CoV-2 infection associated with acute pancreatitis, 11 12 with growing evidence to suggest that the novel coronavirus could be a cause of acute pancreatitis. We believe that the abundant ACE2 expression in pancreatic cells and SARS-CoV-2 using ACE2 to enter human cells is a plausible mechanism.…”

Section: Discussionmentioning

confidence: 99%

Combination of ectopic pancreas and intestinal malrotation presenting as non-specific right iliac fossa pain in a SARS-CoV-2 positive patient

et al. 2021

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We describe the case of a 31-year-old man who presented with a 3-day history of right iliac fossa pain with associated nausea and vomiting. He denied any previous incidents of abdominal pain and had no relevant medical history or family history to note. Given the typical history, examination findings of localised peritonism and infection risk, he was taken to theatre for laparoscopic appendicectomy without diagnostic imaging. Intraoperatively, we noted gut malrotation and an inflammatory jejunal mass which was resected after converting to a mini-laparotomy. The inflammatory mass was reported to be an ectopic pancreatic tissue from histology. Given that this patient had tested positive for SARS-CoV-2 on admission, we propose a possible case of SARS-CoV-2 infection triggering inflammation of the ectopic pancreatic tissue.

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“…Pancreatic cells present high expression of ACE2 receptors and this creates potential for pancreatic injury in the course of COVID-19 (3). However up to date only few COVID-19 related pancreatitis were reported and none in HIV-positive person (4,5). As of today the incidence of pancreatitis and its future clinical implications in this speci c subgroup of patients remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis as Clinical Presentation of COVID-19 in a Patient With HIV Infection – a Case Report.

Kowalska

Bieńkowski

Wojtycha-Kwaśnica

et al. 2021

Preprint

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Background:Acute pancreatitis may be caused by many factors such as: viral infections, drugs, alcohol, autoimmune response. SARS-CoV-2 virus requires an angiotensin-converting enzyme 2 (ACE2) transmembrane protein in order to enter the cell. As ACE2 receptors are over 100 times more common in gastrointestinal (GI) tract than in respiratory tract and many SARS-CoV-2 infected patients present GI symptoms. Case presentation:A 26-year-old, HIV-positive man on effective combined antiretroviral therapy with normal CD4+ lymphocyte count level was consulted at the Emergency Department (ER) with mild COVID-19 symptoms, and referred for home isolation. Two weeks later and three weeks from first symptoms, he returned to ER with a three-day history of nausea and pain in the upper abdomen. He had no symptoms of respiratory tract infection, normal peripheral blood oxygenation and chest X-ray. He was admitted to the hospital and diagnosed with acute pancreatitis basing on the Revised Atlanta Classification. After discharge the patient continued to have food intolerance and abdominal discomfort for several weeks, but COVID-19 did not affect his HIV course. Three months post COVID-19 his anti-SARS-CoV-2 IgM and IgG antibodies were negative, and low level of 2 AU/mL of anti-S-RBD IgG antibodies was detected.Conclusions:SASR-CoV-2 infection is the most likely cause of pancreatitis in the presented patient. Several other case reports were published however none in HIV-positive patient. Therefore in COVID-19 patients serum amylase and lipase levels should be included into routine laboratory tests’ panel. Abdominal ultrasound and CECT should be considered as diagnostic tool in patients with abnormal laboratory findings or clinical manifestation suggesting GI tract involvement.

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

Cited by 48 publications

References 19 publications

Not so sweet and simple: impacts of SARS-CoV-2 on the β cell

Not so sweet and simple: impacts of SARS-CoV-2 on the β cell

Combination of ectopic pancreas and intestinal malrotation presenting as non-specific right iliac fossa pain in a SARS-CoV-2 positive patient

Acute Pancreatitis as Clinical Presentation of COVID-19 in a Patient With HIV Infection – a Case Report.

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