Endocrine Abstracts

Acute pancreatitis (AP) is an inflammatory disorder of the pancreas, most commonly caused by gallstones and heavy alcohol consumption. The diagnosis is established with at least 2 of the following criteria: abdominal pain; increased serum lipase/amylase levels greater than 3 times the upper limit of normal value; or characteristic findings on contrast computed tomography (CT). Since the beginning of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic, a few studies have reported a potential pancreatic injury related to SARS-CoV-2 infection. We are presenting a case of acute pancreatits in a pacient without any relevant risk factors other than a COVID-19 infection. A 74-year-old male with previous history of dyslipidemia and type 2 diabetes mellitus was hospitalized with general malaise, headache and nausea that had last for one week. Chest radiography showed bilateral beginning opacities, and results from testing of transcription polymerase chain reaction assay were positive for SARS-CoV-2. Severe pneumonia developed, with progressive dyspnea and hypoxic respiratory failure that required high-flow oxygen supplementation. We prescribed tocilizumab (anti-interleukin-6 receptor antibody) and corticoids, and so his oxygen requirements declined over the next several weeks, with gradual resolution of his pulmonary symptoms. On day 16, our patient reported diffuse abdominal pain without signs of peritoneal irritation. The blood test showed high levels of leukocytes (30.6 × 10³ µl). The patient presents progressive worsening of abdominal pain with distension, so an abdominal CT is requested. The image showed acute pancreatitis with multiple associated necrohemorrhagic collections. Conservative medical treatment is decided, including bowel rest, intravenous fluids therapy, antibiotics and analgesia. After two days, the patient presented bilious vomiting and paralytic ileus, so he is treated with prokinetics, nasogastric tube, and rectal tube in turns. We also channeled drum for parenteral nutrition. The patient evolved favorably, being able to progress to enteral nutrition and later to oral nutrition, which he tolerated. Hydrolyzed supplements, phosphate and potassium are added. The patient was discharged and a follow-up CT scan was performed one month later, observing a decrease in collections. COVID-19 pathogenesis is thought to be mediated by angiotensin-converting enzyme-2 (ACE-2) receptor on the host cells, which are highly expressed in the pancreatic islets. Though the exact mechanism of AP by SARS-CoV-2 infection is unknown, the cytopathic effect or systemic inflammatory responses to the virus are thought to be responsible. Physicians should consider this possibility sooner or later in the course of COVID-19 illness.