Critical Care and Shock

Acute necrotizing pancreatitis associated with Covid-19: A case report

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Coronavirus infection is commonly associated with pulmonary manifestations. Extra pulmonary manifestations including gastrointestinal involvement is also well established recently in COVID positive patients. However, pancreatic involvement due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is an unusual presentation and therefore much more attention has to be given to the pancreatic injury caused by SARS-CoV-2 infection. There is different pathophysiology behind the pancreatic dysfunction associated with SARS-CoV-2 infection. It can either be the systematic inflammatory immune response causing tissue damage or direct invasion of pancreatic cells. The virus enters the host cells or tissues via its spike protein that binds to the angiotensin-converting enzyme 2 (ACE2) present in the pancreatic islets cells, which in turn leads to pancreatic injury and dysfunction. It can also occur as an adverse effect of medications like ritonavir-lopinavir that is a therapeutic option for COVID-19 patients. Here, we report a case of a patient with COVID-19-induced acute pancreatitis where medical history and further investigations eliminated all the other expected causes of pancreatitis. He came with complaints of hiccups for two weeks and abdominal pain. He tested positive for COVID-19 and was managed with antibiotics like meropenem. Laboratory investigations as well as computed tomography abdomen paved way for the detection of pancreatic involvement. Pancreatic injury and COVID-19 infection were resolved during the course in hospital and the patient was discharged on medications including zinc, vitamin C supplementation, and also with ciprofloxacin.

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