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In this case series, an emerging phenotype of pancreatitis in the setting of COVID-19 is described. Potential unique manifestations found in the 5 patients with no other explanation for pancreatitis include transient hepatic steatosis, with rapid improvement on follow-up CT imaging, mild pancreatic edema without significant peripancreatic/pancreatic necrosis with distinct duodenal/periduodenal inflammation, and accompaniment of profound SIRS response correlated to radiographical findings.
Interestingly patients had transient manifestations of true pancreatic exocrine insufficiency requiring treatment, and, despite profound initial severity in pancreatitis, patients generally had benign courses pertaining to pancreatic insult.
– Arshish Dua, MD
This abstract is available on the publisher's site.
As the global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) continues, nuances of the disease it precipitates in humans continue to emerge. Following early reports of presentation with gastro-intestinal-type symptoms in China1 and Italy2, a group from Wuhan reported a series of 9 patients with purported pancreatic injury in the context of SARS-CoV2 infection3, but did not provide robust evidence for pancreatitis relying on mild hyperamylasaemia alone. Current international consensus for a diagnosis of acute pancreatitis requires two of the following three features: 1) Abdominal pain consistent with pancreatitis; 2) Serum amylase/lipase greater than 3 times the upper limit of normal and 3) Characteristic findings on cross sectional imaging4. Simply put, there are too many causes for hyperamylasaemia in the context of systemic illness, with or without SARS-CoV2, for its use in isolation as a marker of pancreatic injury. None the less, we report here 5 cases of atypical but proven acute pancreatitis in the context of SARS-CoV2 infection.