1
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Devi SM, Pamreddy A, Narendra VR. Risks associated with acute pancreatitis (AP) with diabetic ketoacidosis (DKA) in COVID-19 patients: a literature review. J Diabetes Metab Disord 2023; 22:135-146. [PMID: 37250369 PMCID: PMC10083065 DOI: 10.1007/s40200-023-01207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/28/2023] [Indexed: 05/31/2023]
Abstract
Background SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has become a global pandemic, and medical experts are scrambling to understand the wide range of symptoms and consequences of the virus. Although acute pancreatitis (AP) and pancreatic damage have been associated with SARS-CoV-2, the mechanism behind this is still unclear. The current article explores whether COVID-19 is an additional cause of AP and diabetic ketoacidosis (DKA). The article illustrates the conditions associated with AP and DKA among COVID-19 patients and diabetes mellitus (DM). Another critical condition is acute kidney injury (AKI), often associated with DKA. Methods A search strategy for the article was assigned and retrieved from PubMed, Web of Science, and Scopus databases from 2020 to June 2022. The articles which discussed case studies on AP, DKA, and AKI were included in the study. Results The present review of 24 reported case studies represented conditions of AP (12), DKA (5), AP and DKA (5), AP and AKI (1), and DKA and AKI (1) among COVID-19 participants, and showed a potential relationship between the complications. Conclusion Healthcare during the COVID-19 pandemic plays a major role among AP, DKA, and AKI-associated COVID-19 patients. A compilation of case studies suggests effective management of COVID-19 infection-related complications such as AP, DKA, and AKI.
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Affiliation(s)
- Sundru Manjulata Devi
- Bioinformatics section, SVR BioScience Research Services, 570003 Mysuru, Karnataka India
| | - Annapurna Pamreddy
- Division of Nephrology, Department of Medicine, Long School of Medicine, University of Texas Health, San Antonio, TX USA
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Onur MR, Özbay Y, İdilman İ, Karaosmanoğlu AD, Uysal Ramadan S, Barlık F, Aydın S, Odaman H, Altay C, Başara Akın I, Dicle O, Appak Ö, Gülpınar B, Erden A, Kula S, Gürsöy Çoruh A, Kuru Öz D, Kul M, Uzun Ç, Karavaş E, Levent A, Artaş H, Eryeşil H, Solmaz O, Öztürk Kaygusuz T, Faraşat M, Kale AB, Düzgün F, Pekindil G, Apaydın FD, Nass Duce M, Balcı Y, Esen K, Sağır Kahraman A, Karaca L, Maraş Özdemir Z, Kahraman B, Tosun M, Nural MS, Çamlıdağ İ, Onar MA, Ballı K, Güler E, Harman M, Elmas NZ, Öztürk C, Güngör Ö, Herek D, Yağcı AB, Erol C, Şeker M, İşlek İ, Can Y, Aslan S, Karadeniz Bilgili MY, Göncüoğlu A, Keleş H, Bekin Sarıkaya PZ, Bakır B, Dağoğlu Kartal MG, Durak G, Yücel Oğuzdoğan G, Alper F, Yalçın A, Gürel S, Alan B, Gündoğdu E, Aydın N, Cansu A, Civan Kuş C, Ofluoğlu Tuncer E, Pişkin FC, Çolakoğlu Er H, Değirmenci B, Özmen MN, Kantarcı M, Karçaaltıncaba M. Evaluation of abdominal computed tomography findings in patients with COVID-19: a multicenter study. Diagn Interv Radiol 2023; 29:414-427. [PMID: 36960669 PMCID: PMC10679620 DOI: 10.4274/dir.2022.221575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/13/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the frequency of abdominal computed tomography (CT) findings in patients with coronavirus disease-2019 (COVID-19) and interrogate the relationship between abdominal CT findings and patient demographic features, clinical findings, and laboratory test results as well as the CT atherosclerosis score in the abdominal aorta. METHODS This study was designed as a multicenter retrospective study. The abdominal CT findings of 1.181 patients with positive abdominal symptoms from 26 tertiary medical centers with a positive polymerase chain-reaction test for severe acute respiratory syndrome coronavirus 2 were reviewed. The frequency of ischemic and non-ischemic CT findings as well as the association between CT findings, clinical features, and abdominal aortic calcific atherosclerosis score (AA-CAS) were recorded. RESULTS Ischemic and non-ischemic abdominal CT findings were detected in 240 (20.3%) and 328 (27.7%) patients, respectively. In 147 patients (12.4%), intra-abdominal malignancy was present. The most frequent ischemic abdominal CT findings were bowel wall thickening (n = 120; 10.2%) and perivascular infiltration (n = 40; 3.4%). As for non-ischemic findings, colitis (n = 91; 7.7%) and small bowel inflammation (n = 73; 6.2%) constituted the most frequent disease processes. The duration of hospital stay was found to be higher in patients with abdominal CT findings than in patients without any positive findings (13.8 ± 13 vs. 10.4 ± 12.8 days, P < 0.001). The frequency of abdominal CT findings was significantly higher in patients who did not survive the infection than in patients who were discharged after recovery (41.7% vs. 27.4%, P < 0.001). Increased AA-CAS was found to be associated with a higher risk of ischemic conditions in abdominal CT examinations. CONCLUSION Abdominal symptoms in patients with COVID-19 are usually associated with positive CT findings. The presence of ischemic findings on CT correlates with poor COVID-19 outcomes. A high AA-CAS is associated with abdominal ischemic findings in patients with COVID-19.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yakup Özbay
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - İlkay İdilman
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Selma Uysal Ramadan
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Funda Barlık
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sonay Aydın
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hüseyin Odaman
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Işıl Başara Akın
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Oğuz Dicle
- Department of Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Özgür Appak
- Department of Medical Microbiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Başak Gülpınar
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Erden
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sezer Kula
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Diğdem Kuru Öz
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Melahat Kul
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdal Karavaş
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Akın Levent
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hakan Artaş
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Hasan Eryeşil
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Onur Solmaz
- Department of Radiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Türkkan Öztürk Kaygusuz
- Department of Infectious Diseases and Clinical Microbiology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Mustafa Faraşat
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Ahmet Burak Kale
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Fatih Düzgün
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Gökhan Pekindil
- Department of Radiology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - F. Demir Apaydın
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Meltem Nass Duce
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Kaan Esen
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - Leyla Karaca
- Department of Radiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Bayram Kahraman
- Clinic of Radiology, Specialist Doctor Bayram Kahraman Radiology Clinic, Malatya, Turkey
| | - Mesude Tosun
- Department of Radiology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Mehmet Selim Nural
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - İlkay Çamlıdağ
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Arda Onar
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Kaan Ballı
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ezgi Güler
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Mustafa Harman
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Nevra Zehra Elmas
- Department of Radiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Cansu Öztürk
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Özlem Güngör
- Clinic of Radiology, University of Health Sciences Turkey, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, Turkey
| | - Duygu Herek
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baki Yağcı
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Cengiz Erol
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Şeker
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - İrem İşlek
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Yusuf Can
- Department of Radiology, Medipol University Faculty of Medicine, İstanbul, Turkey
| | - Serdar Aslan
- Department of Radiology, Giresun University Faculty of Medicine, Giresun, Turkey
| | | | - Alper Göncüoğlu
- Department of Radiology, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | - Hatice Keleş
- Department of Internal Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey
| | | | - Barış Bakır
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | | | - Görkem Durak
- Department of Radiology, İstanbul University, İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Gülşen Yücel Oğuzdoğan
- Clinic of Radiology, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Fatih Alper
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ahmet Yalçın
- Department of Radiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Safiye Gürel
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Bircan Alan
- Department of Radiology, Bolu Abant İzzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Elif Gündoğdu
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Nevin Aydın
- Department of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ayşegül Cansu
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ceyda Civan Kuş
- Clinic of Radiology, Marmara University Training and Research Hospital, İstanbul, Turkey
| | - Elif Ofluoğlu Tuncer
- Clinic of Radiology, University of Health Sciences Turkey, Sultan 2. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Ferhat Can Pişkin
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Hale Çolakoğlu Er
- Department of Radiology, Ufuk University Faculty of Medicine, Ankara, Turkey
| | | | - Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mecit Kantarcı
- Department of Radiology, Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
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Teng TZJ, Chua BQY, Lim PK, Chan KS, Shelat VG. Occam’s razor or Hickam’s dictum-COVID-19 is not a textbook aetiology of acute pancreatitis: A modified Naranjo Score appraisal. World J Gastroenterol 2023; 29:2050-2063. [PMID: 37155526 PMCID: PMC10122789 DOI: 10.3748/wjg.v29.i13.2050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a disease spectrum ranging from mild to severe disease. During the coronavirus disease 2019 (COVID-19) pandemic, numerous reports of AP have been published, with most authors concluding a causal relationship between COVID-19 and AP. Retrospective case reports or small case series are unable to accurately determine the cause-effect relationship between COVID-19 and AP.
AIM To establish whether COVID-19 is a cause of AP using the modified Naranjo scoring system.
METHODS A systematic review was conducted on PubMed, World of Science and Embase for articles reporting COVID-19 and AP from inception to August 2021. Exclusion criteria were cases of AP which were not reported to be due to COVID-19 infection, age < 18 years old, review articles and retrospective cohort studies. The original 10-item Naranjo scoring system (total score 13) was devised to approximate the likelihood of a clinical presentation to be secondary to an adverse drug reaction. We modified the original scoring system into a 8-item modified Naranjo scoring system (total score 9) to determine the cause-effect relationship between COVID-19 and AP. A cumulative score was decided for each case presented in the included articles. Interpretation of the modified Naranjo scoring system is as follows: ≤ 3: Doubtful, 4-6: Possible, ≥ 7: Probable cause.
RESULTS The initial search resulted in 909 articles, with 740 articles after removal of duplicates. A total of 67 articles were included in the final analysis, with 76 patients which had AP reported to be due to COVID-19. The mean age was 47.8 (range 18-94) years. Majority of patients (73.3%) had ≤ 7 d between onset of COVID-19 infection and diagnosis of AP. There were only 45 (59.2%) patients who had adequate investigations to rule out common aetiologies (gallstones, choledocholithiasis, alcohol, hypertriglyceridemia, hypercalcemia and trauma) of AP. Immunoglobulin G4 testing was conducted in 9 (13.5%) patients to rule out autoimmune AP. Only 5 (6.6%) patients underwent endoscopic ultrasound and/or magnetic resonance cholangiopancreatogram to rule out occult microlithiasis, pancreatic malignancy and pancreas divisum. None of the patients had other recently diagnosed viral infections apart from COVID-19 infection, or underwent genetic testing to rule out hereditary AP. There were 32 (42.1%), 39 (51.3%) and 5 (6.6%) patients with doubtful, possible, and probable cause-effect relationship respectively between COVID-19 and AP.
CONCLUSION Current evidence is weak to establish a strong link between COVID-19 and AP. Investigations should be performed to rule out other causes of AP before establishing COVID-19 as an aetiology.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Branden Qi Yu Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Puay Khim Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kai Siang Chan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Surgical Science Training Centre, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Boraschi P, Donati F, Ambrosini I, Bruni L, Mazzeo ML, Tintori R, Tonerini M, Neri E. Diagnostic and Therapeutic Radiology of the GI Tract, Liver, and Pancreas in Patients with COVID. Gastroenterol Clin North Am 2023; 52:185-200. [PMID: 36813425 PMCID: PMC9626443 DOI: 10.1016/j.gtc.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pulmonary involvement has been extensively reported in the literature. Current data highlight how COVID-19 is a systemic disease, affecting many other organs, including the gastrointestinal, hepatobiliary, and pancreatic organs. Recently, these organs have been investigated using imaging modalities of ultrasound and particularly computed tomography. Radiological findings of the gastrointestinal, hepatic, and pancreatic involvement in patients with COVID-19 are generally nonspecific but are nonetheless helpful to evaluate and manage COVID-19 patients with involvement of these organs.
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Affiliation(s)
- Piero Boraschi
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy.
| | - Francescamaria Donati
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Ilaria Ambrosini
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Luciana Bruni
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Maria Letizia Mazzeo
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
| | - Rachele Tintori
- 2nd Unit of Radiology, Department of Diagnostic and Interventional Radiology, and Nuclear Medicine, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Michele Tonerini
- Unit of Emergency Radiology, Department of Surgical, Medical, Molecular and Critical Area Pathology, Pisa University Hospital, Via Paradisa 2, Pisa 56124, Italy
| | - Emanuele Neri
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, Pisa 56126, Italy
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Amanati A, Shahriari M, Bordbar MR, Hedayati SB, Ziyaeyan M, Jamalidoust M, Kalani M, Heydari Marandi N. Severe acute respiratory syndrome coronavirus-2 Alpha variant (B.1.1.7), original wild-type severe acute respiratory syndrome coronavirus 2, and cytomegalovirus co-infection in a young adult with acute lymphoblastic leukemia, case report, and review of the possible cytomegalovirus reactivation mechanisms. J Med Case Rep 2023; 17:66. [PMID: 36765433 PMCID: PMC9913040 DOI: 10.1186/s13256-022-03750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Like other viral infections, severe acute respiratory syndrome coronavirus-2 infection could affect different human body systems, including host immune responses. Three years after its pandemic, we learn more about this novel coronavirus. As we expected, different co-infections with various organisms, such as viruses, bacteria, and even fungi, have been reported. However, concurrent infection with two severe acute respiratory syndrome coronavirus-2 strains and cytomegalovirus is extremely unusual. We have only a rudimentary understanding of such co-infections and their long-term consequences for patients with cancer. CASE PRESENTATION An 18-year-old young Iranian adult with acute lymphoblastic leukemia presented with abdominal pain, diarrhea, nausea, and vomiting following a recent history of severe acute respiratory syndrome coronavirus-2 infection. The patient never experienced respiratory symptoms, and the chest imaging study was normal on admission. His primary laboratory investigation revealed prerenal azotemia and severe abnormal liver function tests (blood urea nitrogen 32 mg/dL, creatinine 1.75 mg/dL, prothrombin time 66 s, partial thromboplastin time 44.5 s, international normalized ratio 5.14, total bilirubin 2.9 mg/dL, and direct bilirubin 2.59 mg/dL). Cytomegalovirus disease was diagnosed by polymerase chain reaction in his blood and stool samples. The patient's gastrointestinal signs and symptoms improved shortly after receiving intravenous ganciclovir treatment. His gastrointestinal symptoms continued intermittently for weeks despite maintenance valganciclovir prescription, necessitating frequent hospitalizations. The patient was complicated by the recurrence of gastrointestinal symptoms during the sixth hospitalization, even though he had no respiratory symptoms, and the nasopharyngeal test revealed severe acute respiratory syndrome coronavirus-2 Wuhan strain for the first time. Remdesivir and valganciclovir were administrated due to persistent enteritis and evidence of intestinal tissue invasion by severe acute respiratory syndrome coronavirus 2 and cytomegalovirus on multiple intestinal biopsies, which led to partial clinical responses. Cytomegalovirus and severe acute respiratory syndrome coronavirus-2 fecal shedding continued for more than 6 months despite repeated antiviral therapy, and the Wuhan and Alpha strains were also detected in his nasopharyngeal samples through repeated sampling (confirmed by four nasopharyngeal sampling and multiple stool specimens and several intestinal biopsies). Finally, during the Delta-variant (B.1.617.2) outbreak in Iran, the patient was admitted again with febrile neutropenia and decreased level of consciousness, necessitating respiratory support and mechanical ventilation. During the Delta-variant peak, the patient's nasopharyngeal sample once more tested positive for severe acute respiratory syndrome coronavirus 2. The patient died a few days later from cardiopulmonary arrest. CONCLUSION The coronavirus disease 2019 pandemic has encountered patients with cancer with critical diagnostic and treatment challenges. Patients who are immunocompromised may co-infect with multiple severe acute respiratory syndrome coronavirus-2 strains and cytomegalovirus, and even with timely diagnosis and treatment, the prognosis may be poor.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Departments of Pediatrics, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mahdi Shahriari
- The Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Mazyar Ziyaeyan
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Jamalidoust
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Kalani
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Heydari Marandi
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Kerawala AA, Das B, Fatima R, Solangi A. COVID-19 and pancreatitis: A review of the potential association. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2023. [DOI: 10.18528/ijgii210060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Asad Ali Kerawala
- Department of Surgery, Cancer Foundation Hospital, Karachi, Pakistan
| | - Bhagwan Das
- Department of Endocrinology, Cancer Foundation Hospital, Karachi, Pakistan
| | - Rabika Fatima
- Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan
| | - Ahda Solangi
- Department of Medicine, New York Medical College, Valhalla, NY, USA
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7
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Tang Q, Gao L, Tong Z, Li W. Hyperlipidemia, COVID-19 and acute pancreatitis: A tale of three entities. Am J Med Sci 2022; 364:257-263. [PMID: 35381217 PMCID: PMC8977370 DOI: 10.1016/j.amjms.2022.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/04/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the ongoing pandemic of coronavirus disease 2019 (COVID-19), which presented as not only respiratory symptoms, but various digestive manifestations including pancreatic injury and acute pancreatitis (AP). The underlying mechanism is still unclear. Hypertriglyceridemia has become one of the leading causes of AP in recent years and hyperlipidemia is highly reported in COVID-19 cases. The current narrative review aimed to explore the associations between AP, COVID-19 and hyperlipidemia. Substantial cases of COVID-19 patients complicated with AP were reported, while the incidence of AP in the COVID-19 population was relatively low. Hyperlipidemia was common in COVID-19 patients with a pooled incidence of 32.98%. Hyperlipidemia could be a mediating factor in the pathogenesis of AP in COVID-19 patients. Further studies are warranted to clarify the relationship among AP, lipid metabolism disorders and COVID-19.
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Affiliation(s)
- Qiuyi Tang
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Lin Gao
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China
| | - Zhihui Tong
- Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
| | - Weiqin Li
- Medical School, Southeast University, Nanjing, Jiangsu, China; Center of Severe Acute Pancreatitis (CSAP), Department of Intensive Care Unit, Jinling Hospital, Nanjing, Jiangsu, China.
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8
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Aziz AA, Aziz MA, Saleem M, Haseeb Ul Rasool M. Acute Pancreatitis Related to COVID-19 Infection: A Systematic Review and Analysis of Data. Cureus 2022; 14:e28380. [PMID: 36168341 PMCID: PMC9506667 DOI: 10.7759/cureus.28380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 01/09/2023] Open
Abstract
There is increasing literature mentioning severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19 infection) causing acute pancreatitis (AP). It is hypothesized that SARS-Cov-2 causes pancreatic injury either by direct cytotoxic effect of the virus on pancreatic cells through the angiotensin-converting enzyme 2 (ACE2) receptors - the main receptors for the virus located on pancreatic cells - or by the cytokine storm that results from COVID-19 infection or a component of both. Many viruses are related to AP including mumps, coxsackievirus, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and as data evolves SARS-CoV-2 virus may be one of them as well. We conducted a systematic literature review to explore the current literature and provide an overview of the evidence of AP in COVID-19 infection. We studied the presence of AP in patients with SARS-CoV-2 infection and calculated the time of diagnosis of SARS-CoV-2 infection with respect to the time of diagnosis of AP. We also studied the age, gender, clinical manifestations, time of onset of symptoms, laboratory values, imaging findings, mortality, length of stay, comorbidities, need for Intensive Care Unit (ICU) care, and excluded any other common causes of AP. We included 40 articles comprising 46 patients. All patients had a positive SARS-CoV-2 polymerase chain reaction (PCR) test and all patients had AP as per Atlanta's criteria. The most common clinical presentation was abdominal pain in 29 (63.0%). Edematous pancreas was the most common Computed Tomography Abdomen Pelvis (CTAP) scan finding in these patients (35 patients). Seventeen (37%) patients required ICU admission and six (13%) patients died. Our study provides an important overview of the available data on AP in COVID-19 patients and concludes that AP is an important complication in COVID-19 infection and should be considered as an important differential in patients with COVID-19 infection who complain of abdominal pain.
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Affiliation(s)
- Ahmed Ali Aziz
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | | | - Maleeha Saleem
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
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Georgakopoulou VE, Gkoufa A, Garmpis N, Makrodimitri S, Papageorgiou CV, Barlampa D, Garmpi A, Chiapoutakis S, Sklapani P, Trakas N, Damaskos C. COVID-19 and Acute Pancreatitis: A Systematic Review of Case Reports and Case Series. Ann Saudi Med 2022; 42:276-287. [PMID: 35933608 PMCID: PMC9357298 DOI: 10.5144/0256-4947.2022.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 04/13/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) presents mainly with mild symptoms and involvement of the respiratory system. Acute pancreatitis has also been reported during the course of COVID-19. OBJECTIVE Our aim is to review and analyze all reported cases of COVID-19 associated acute pancreatitis, reporting the demographics, clinical characteristics, laboratory and imaging findings, comorbidities and outcomes. DATA SOURCES We conducted a systematic search of Pubmed/MEDLINE, SciELO and Google Scholar to identify case reports and case series, reporting COVID-19 associated acute pancreatitis in adults. STUDY SELECTION There were no ethnicity, gender or language restrictions. The following terms were searched in combination:"COVID-19" OR "SARS-CoV-2" OR "Coronavirus 19" AND "Pancreatic Inflammation" OR "Pancreatitis" OR "Pancreatic Injury" OR "Pancreatic Disease" OR "Pancreatic Damage". Case reports and case series describing COVID-19 associated acute pancreatitis in adults were included. COVID-19 infection was established with testing of nasal and throat swabs using reverse transcription polymerase chain reaction. The diagnosis of acute pancreatitis was confirmed in accordance to the revised criteria of Atlanta classification of the Acute Pancreatitis Classification Working Group. Exclusion of other causes of acute pancreatitis was also required for the selection of the cases. DATA EXTRACTION The following data were extracted from each report: the first author, year of publication, age of the patient, gender, gastrointestinal symptoms due to acute pancreatitis, respiratory-general symptoms, COVID-19 severity, underlying diseases, laboratory findings, imaging features and outcome. DATA SYNTHESIS Finally, we identified and analyzed 31 articles (30 case reports and 1 case series of 2 cases), which included 32 cases of COVID-19 induced acute pancreatitis. CONCLUSION COVID-19 associated acute pancreatitis affected mostly females. The median age of the patients was 53.5 years. Concerning laboratory findings, lipase and amylase were greater than three times the ULN while WBC counts and CRP were elevated in the most of the cases. The most frequent gastrointestinal, respiratory and general symptom was abdominal pain, dyspnea and fever, respectively. The most common imaging feature was acute interstitial edematous pancreatitis and the most frequent comorbidity was arterial hypertension while several patients had no medical history. The outcome was favorable despite the fact that most of the patients experienced severe and critical illness. LIMITATIONS Our results are limited by the quality and extent of the data in the reports. More specifically, case series and case reports are unchecked, and while they can recommend hypotheses they are not able to confirm robust associations. CONFLICT OF INTEREST None.
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Affiliation(s)
| | - Aikaterini Gkoufa
- From the First Department of Internal Medicine, Laiko General Hospital, Athens, Greece
| | - Nikolaos Garmpis
- From the Second Department of Propedeutic Surgery, Laiko General Hospital, Athens, Greece
| | | | | | - Danai Barlampa
- From the Department of Internal Medicine, Medical Center of Megalopolis, Arcadia, Greece
| | - Anna Garmpi
- From the First Department of Internal Medicine, Laiko General Hospital, Athens, Greece
| | - Serafeim Chiapoutakis
- From the Department of Thoracic Surgery, Agios Savvas General Cancer and Oncology Hospital of Athens, Athens, Greece
| | - Pagona Sklapani
- From the Department of Cytology, Mitera Maternity Hospital, Athens, Greece
| | - Nikolaos Trakas
- From the Department of Biochemistry, Sismanogleio General Hospital, Athens, Greece
| | - Christos Damaskos
- From the Renal Transplantation Unit, Laiko General Hospital, Athens, Greece
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A Pilot Study on COVID-19 Positive Subjects: An Excerpt of Post-Infection-Pro-Diabetic Disposition & Related Consequences in Correlation to Hepato-Pancreatic Bio-Markers, Pro-Inflammatory Cytokines and Other Risk Factors. Indian J Clin Biochem 2022; 38:182-192. [PMID: 35756691 PMCID: PMC9206463 DOI: 10.1007/s12291-022-01054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/18/2022] [Indexed: 01/08/2023]
Abstract
COVID-19, a global pandemic that led to increased morbidity and mortality worldwide since its outcome at the end of the year 2019. A newly discovered variant of severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2) was the arbitrator for spreading the syndrome by droplet transmission causing multi-organ failure in many occasions. A post-infection-pro-diabetic disposition was found evident in this study with the persistence of hepato-pancreatic aberrations in respect of reference range of tissue specific bio-markers in hospital admitted COVID-19 cases. The results of this study show that hyperglycemia is a risk factor in precipitating disease oriented complications to the patients with COVID-19 disease. A post-infection follow- up on glycemic-index and related complexities is a vital need to the COVID-19 infected convalescent subjects. Implementation of guidelines on social measure and awareness of anti-viral interventions may be the only way to prevent COVID-19 transmission.
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COŞKUN O, ÇAPRAZ M, CİHANGİROĞLU M, KAYA AT. Is hyperlipazemia a poor prognostic factor in patients with COVID-19 ? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1057456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: COVID-19 disease may pose a considerable health threat to healthy individuals and individuals with comorbidity. The SARS-CoV-2 virus affects the respiratory tract and may cause damage to the pancreas by binding to the ACE-2 receptor in the pancreas. In our study, we investigated the effects of hyperlipasemia on morbidity and mortality in patients diagnosed with COVID-19.
Material and Method: In this study, 2350 patients diagnosed with COVID-19 between November 2020 and December 2020 were retrospectively reviewed. Other possible causes of hyperlipasemia were excluded. Hyperlipasemia secondary to COVID-19 was detected in 338 patients. These patients were divided into two groups based on their lipase elevation rates.
Results: Hyperlipasemia was detected in 14.4% of the patients diagnosed with COVID-19, and severe hyperlipasemia (>3x) was detected in 2.3%. The mean age of the patients was 64±13.8 (18-92), of which 59.5% (201) were male. In our study, 24 patients (1%) were diagnosed with acute pancreatitis. When compared according to lipase level, a significant difference was found between the groups regarding the history of HT, CCI score, development of ARF at follow-up, development of ARDS, need for ICU hospitalization, need for intubation, length of stay in ICU, and death rates. A weak correlation was found in the correlation analysis between hyperlipasemia and ARDS development and mortality.
Conclusion: Elevated lipase levels were associated with poor prognosis and mortality in patients with COVID-19 infection.
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Onoyama T, Koda H, Hamamoto W, Kawahara S, Sakamoto Y, Yamashita T, Kurumi H, Kawata S, Takeda Y, Matsumoto K, Isomoto H. Review on acute pancreatitis attributed to COVID-19 infection. World J Gastroenterol 2022; 28:2034-2056. [PMID: 35664035 PMCID: PMC9134139 DOI: 10.3748/wjg.v28.i19.2034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/20/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) is known to cause gastrointestinal symptoms. Recent studies have revealed COVID-19-attributed acute pancreatitis (AP). However, clinical characteristics of COVID-19-attributed AP remain unclear. We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database. Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2, key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into the pancreas. The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells, and thus, SARS-CoV-2 may have a direct involvement in pancreatic disorders. Additionally, systemic inflammation, especially in children, may cause AP. Levels of immune mediators associated with AP, including interleukin (IL)-1β, IL-10, interferon-γ, monocyte chemotactic protein 1, and tumor necrosis factor-α are higher in the plasma of patients with COVID-19, that suggests an indirect involvement of the pancreas. In real-world settings, some clinical features of AP complicate COVID-19, such as a high complication rate of pancreatic necrosis, severe AP, and high mortality. However, clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP. Therefore, high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.
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Affiliation(s)
- Takumi Onoyama
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Hiroki Koda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Wataru Hamamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Shiho Kawahara
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Yuri Sakamoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Taro Yamashita
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Hiroki Kurumi
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Soichiro Kawata
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Yohei Takeda
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
| | - Kazuya Matsumoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
- Department of Internal Medicine, Irisawa Medical Clinic, Matsue 690-0025, Shimane Prefecture, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori Prefecture, Japan
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Arche Banzo MJ, Matute Guerrero A, Herrero García S. Acute necro-hemorrhagic pancreatitis during SARS-CoV-2 infection. MEDICINA CLINICA (ENGLISH ED.) 2022; 158:346-347. [PMID: 35224202 PMCID: PMC8858696 DOI: 10.1016/j.medcle.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- María José Arche Banzo
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Sandra Herrero García
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Razafindrazoto CI, Hasina Laingonirina DH, Ralaizanaka BM, Randriamifidy NH, Rakotomaharo M, Randrianiaina AF, Rakotoniaina H, Maherison S, Rakotomalala JA, Rasolonjatovo AS, Rakotozafindrabe ALR, Rabenjanahary TH, Razafimahefa SH, Ramanampamonjy RM. COVID-19 Induced Acute Pancreatitis in a Malagasy Woman Patient: Case Report and Literature Review. Int Med Case Rep J 2022; 15:125-134. [PMID: 35378975 PMCID: PMC8976519 DOI: 10.2147/imcrj.s355276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background Case Presentation Conclusion
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Affiliation(s)
- Chantelli Iamblaudiot Razafindrazoto
- Unity of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
- Correspondence: Chantelli Iamblaudiot Razafindrazoto, Unity of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, Tel +261342315887, Email
| | | | | | | | - Mialitiana Rakotomaharo
- Unity of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | | | - Henintsoa Rakotoniaina
- Unity of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - Sonny Maherison
- Unity of Gastroenterology, University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
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Balthazar JA, Chehter EZ. Acute pancreatitis and COVID-19: a new target for infection? EINSTEIN-SAO PAULO 2022; 20:eRW6667. [PMID: 35195163 PMCID: PMC8815337 DOI: 10.31744/einstein_journal/2022rw6667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
This review aimed to investigate whether SARS-CoV-2 is capable of infecting the gland and causing acute pancreatitis, and the peculiarities in the management of these cases. The research was conducted through PubMed® database, and 62 articles were systematically selected for analysis. Differences were found in the literature; however, there are important warnings, such as the presence of hyperlipasemia, clinical and imaging findings suggestive of acute pancreatitis in the presence and even in the absence of respiratory symptoms. Attention should be paid to clinical and imaging findings during this virus infection, since it is possible to identify these two diseases early. Therefore, it is possible to detect and isolate these patients more quickly, providing the correct care and decreasing the morbidity and mortality of two potentially severe diseases.
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Samir A, Elnekeidy A, El-Kady E. COVID-19 infection initially presented by interstitial edematous pancreatitis and acute peri-pancreatic collection; the first CT case report in Egypt. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [PMCID: PMC8450725 DOI: 10.1186/s43055-021-00611-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The extra-pulmonary computed tomography (CT) findings of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease 2019 (COVID-19) have been described in the literature, including the neurologic, cardiac, and abdominal manifestations. Ischemic and inflammatory bowel changes were the most frequent abdominal CT findings. Acute pancreatitis was seldom found all over the world outside of China and described in case reports, but not in Egypt. Case presentation A 44-years-old female patient presented with severe abdominal pain, vomiting, and mild fever for six days. No respiratory symptoms were encountered till the time of the radiological investigation. Abdominal CT examination revealed interstitial edematous pancreatitis with acute peri-pancreatic fluid collection according to the revised Atlanta classification. No pancreatic necrosis or vascular complications were depicted. Secondary pyloro-duodenitis was noticed. The modified Balthazar CT-severity index was moderate (6/10). Basal chest scans showed bilateral variable-sized bronchocentric and sub-pleural consolidative pneumonic patches with mild bilateral pleural effusion. The patient was admitted to the intensive-care unit (ICU) for two weeks. The serum amylase and lipase titers were elevated and the polymerase chain reaction (PCR) test for COVID-19 was positive. She received pancreatic, circulatory, and pulmonary medical support, then she was discharged after stabilization of her condition. Conclusion The authors provided this case report for the association between COVID-19 infection and acute pancreatitis, which is mostly the first in Egypt. It documented their Egyptian experience to be added to the international literature. It radiologically described their chest and abdominal CT findings in detail using the COVID-19 Reporting and Data System (CO-RADS) and the revised Atlanta classification with modified Balthazar CT-severity index (CTSI). This could eventually enrich the radiological point of view in addition to the previously published clinical case reports.
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Gadiparthi C, Mohapatra S, Kanna S, Vykuntam V, Chen W. Acute pancreatitis in a patient with COVID-19: a case report. Transl Gastroenterol Hepatol 2021; 6:65. [PMID: 34805587 DOI: 10.21037/tgh-20-234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
The global pandemic of coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is predominantly a respiratory illness, but gastrointestinal (GI) manifestations of variable severity have been reported. In patients with COVID-19 pneumonia, observational studies have demonstrated the elevation of pancreatic enzymes as surrogate markers for pancreatic injury without evidence of acute pancreatitis (AP). We report a case of AP in a patient with COVID-19 with SARS-CoV-2 as possible etiological agent with imaging evidence of pancreatitis. We hypothesize a causal relationship of SARS-CoV-2 in this patient with an otherwise unexplained presentation of AP after excluding the common causes. We postulate that AP in COVID-19 could be related to the abundant expression of angiotensin converting enzyme 2 (ACE 2) receptors in the pancreas which serve as viral entry binding receptors for SARS-CoV-2 or due to direct viral involvement of the pancreas. Although there seems to be an association between diabetes and AP, the available data regarding the etiological role of diabetes in causing AP is very limited. We also propose that imaging studies such as computerized tomography (CT) scan of the abdomen should be considered in the diagnosis of AP in patients with COVID-19 infection to exclude the false positive amylase and lipase.
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Affiliation(s)
- Chiranjeevi Gadiparthi
- Department of Gastroenterology and Hepatology, Saint Peter's University Hospital-Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA
| | - Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Saint Peter's University Hospital-Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA
| | - Sowjanya Kanna
- Department of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Vinit Vykuntam
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - William Chen
- Department of Gastroenterology and Hepatology, Saint Peter's University Hospital-Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA
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Goyal H, Kopel J, Ristić B, Perisetti A, Anastasiou J, Chandan S, Tharian B, Inamdar S. The pancreas and COVID-19: a clinical conundrum. Am J Transl Res 2021; 13:11004-11013. [PMID: 34786039 PMCID: PMC8581906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
With the progression of the COVID-19 pandemic, the classic manifestations of COVID-19 (e.g., persistent fever, dry cough, pneumonia, and acute respiratory distress syndrome in the severe disease) have expanded to include less common complications of the extrapulmonary organs. Recent evidence has shown that COVID-19 patients with concomitant presence of GI symptoms are at higher risk of developing severe disease and have poor clinical outcomes. Recently, multiple SARS-CoV-2-induced acute pancreatitis (AP) cases have been reported. This literature review aims to provide an insight into SARS-CoV-2-directed invasion of the pancreas. We will also review the currently available literature on the clinical effects of SARS-CoV-2, including AP and mild elevation of lipase levels in patients with COVID-19. In addition, we will discuss plausible mechanisms that underly SARS-CoV-2-induced pancreatitis.
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Affiliation(s)
- Hemant Goyal
- The Wright Center for Graduate Medical EducationScranton, PA, USA
| | - Jonathan Kopel
- Department of Medicine, Texas Tech University Health Sciences CenterLubbock, TX, USA
| | - Bojana Ristić
- Cell Biology and Biochemistry, Texas Tech University Health Sciences CenterLubbock, TX, USA
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical SciencesLittle Rock, AR, USA
| | - Jiannis Anastasiou
- Central Arkansas Veterans Healthcare SystemLittle Rock, AR, USA
- Division of Gastroenterology, University of Arkansas for Medical SciencesLittle Rock, AR, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical CenterOmaha, Nebraska, USA
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical SciencesLittle Rock, AR, USA
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical SciencesLittle Rock, AR, USA
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Abdominal imaging findings on computed tomography in patients acutely infected with SARS-CoV-2: what are the findings? Emerg Radiol 2021; 28:1087-1096. [PMID: 34601700 PMCID: PMC8487449 DOI: 10.1007/s10140-021-01986-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 11/07/2022]
Abstract
Objectives To investigate what findings are new on contrast-enhanced abdominopelvic CT in patients infected with SARS-CoV-2. Methods Contrast-enhanced CT of the abdomen and pelvis of patients with COVID-19 at a tertiary oncologic center acquired over a 2-month period were reviewed independently by two readers and scored for new imaging abnormalities compared with a prior scan. CT scans were included if the study was performed between − 3 and 45 days from the time of COVID-19 diagnosis. Clinical information was gathered from the medical records. Results A total of 63 patients (34 male, 29 female; mean age 60.6 years, range 24.4–85.0 years) were included in this retrospective cross-sectional study. Aside from new ground glass opacities seen at the lung bases (29/63, 46.0%), the most common findings were new thickening of the stomach, small bowel or colon or fluid-filled colon (14/63, 22.2%), new small volume ascites (7/63, 14.3%), gallbladder distention in those without prior cholecystectomy (3/43, 7.0%), and single cases each of acute pancreatitis (1/63, 1.6%) as well as new portal vein thrombosis (1/63, 1.6%). Conclusion Aside from lung base ground glass opacities, the most common new imaging abnormality on abdominopelvic CT in patients with COVID-19 finding in our cohort was abnormalities of the gastrointestinal tract, followed by small volume ascites, gallbladder distention, and isolated cases of pancreatitis and portal vein thrombosis. These findings overlap with those previously reported that did not have a prior scan for comparison, and provide supportive evidence that some of these findings may be related to SARS-CoV-2 infection.
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Eldaly AS, Fath AR, Mashaly SM, Elhadi M. Acute pancreatitis associated with severe acute respiratory syndrome coronavirus-2 infection: a case report and review of the literature. J Med Case Rep 2021; 15:461. [PMID: 34503570 PMCID: PMC8426586 DOI: 10.1186/s13256-021-03026-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction We report a case of Severe acute respiratory syndrome coronavirus-2 infection with acute pancreatitis as the only presenting symptom. To the best of our knowledge, there are few case reports of the same presentation. Case presentation An otherwise healthy 44-year-old white male from Egypt presented to the hospital with severe epigastric pain and over ten attacks of nonprojectile vomiting (first, gastric content, then bilious). Acute pancreatitis was suspected and confirmed by serum amylase, serum lipase, and computed tomography scan that showed mild diffuse enlargement of the pancreas. The patient did not have any risk factor for acute pancreatitis, and extensive investigations did not reveal a clear etiology. Given a potential occupational exposure, a nasopharyngeal swab for polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was done, which was positive despite the absence of the typical symptoms of severe acute respiratory syndrome coronavirus 2 such as fever and respiratory symptoms. The patient was managed conservatively. For pancreatitis, he was kept nil per os for 2 days and received intravenous lactated Ringer’s (10 ml per kg per hour), nalbuphine, alpha chymotrypsin, omeprazole, and cyclizine lactate. For severe acute respiratory syndrome coronavirus 2, he received a 5-day course of intravenous azithromycin (500 mg per day). He improved quickly and was discharged by the fifth day. We know that abdominal pain is not a rare symptom of severe acute respiratory syndrome coronavirus 2, and we also know that elevated levels of serum amylase and lipase were reported in severe acute respiratory syndrome coronavirus-2 patients, especially those with severe symptoms. However, the association between severe acute respiratory syndrome coronavirus-2 infection and idiopathic acute pancreatitis is rare and has been reported only a few times. Conclusion We believe further studies should be conducted to determine the extent of pancreatic involvement in severe acute respiratory syndrome coronavirus-2 patients and the possible causality between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis. We reviewed the literature regarding the association between severe acute respiratory syndrome coronavirus 2 and acute pancreatitis patients. Published data suggest that severe acute respiratory syndrome coronavirus 2 possibly could be a risk factor for acute pancreatitis.
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Affiliation(s)
- Abdullah S Eldaly
- Plastic and Reconstructive Surgery Department, Tanta University Hospital, Tanta, Egypt
| | - Ayman R Fath
- Internal Medicine Department, Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA
| | | | - Muhammed Elhadi
- Faculty of Medicine, University of Tripoli, University Road, Furnaj, 13275, Tripoli, Libya.
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21
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Jariwala PV, Jadhav KP, Aurangabadkar H, Dommata RR. Left ventricular thrombus with normal systolic function secondary to the novel prothrombotic association of acute on chronic calcific pancreatitis and COVID-19. J Cardiol Cases 2021; 25:55-57. [PMID: 34257751 PMCID: PMC8266266 DOI: 10.1016/j.jccase.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/12/2021] [Accepted: 06/16/2021] [Indexed: 12/23/2022] Open
Abstract
In the presence of normal left ventricular systolic function, the development of left ventricular thrombus has seldom been documented in hypercoagulable conditions. Echocardiographic results of left ventricular thrombi can be differentiated from those found in cardiac tumors such as myxoma. Many other organs, including the central and peripheral nervous systems, as well as the cardiac and vascular systems, have recently been linked to thromboembolic events in coronavirus disease 2019 (COVID-19). It not only exacerbates acute pancreatitis but often predisposes, in fact, to a novel prothrombotic state in patients with pre-existing comorbid conditions such as chronic calcific pancreatitis. We report an unusual correlation of two prothrombotic disorders - COVID-19 and acute on chronic pancreatitis contributing to the development of thrombus in a normal left ventricle. <Learning objective: Intra-cardiac thrombus in a normal functioning left ventricle has not been described in severe SARS-CoV-2 infection. The triple association of COVID-19, acute pancreatitis, and left ventricular thrombus is an extremely rare and fatal disorder. Echocardiography is an easy bedside tool to diagnose intra-cardiac left ventricular thrombus formation in COVID-19 patients with high D-dimer values.>.
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Affiliation(s)
- Pankaj V. Jariwala
- Department of Cardiology, Yashoda Hospital, Somajiguda, Hyderabad 500082, India
- Corresponding author.
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22
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Agarwal L, Agarwal A, Advani S, Katiyar V, Chaturvedi A, Madhusudhan KS. The eyes see what the mind seeks: a systematic review of abdominal imaging findings in patients with COVID-19. Br J Radiol 2021; 94:20201220. [PMID: 34260323 PMCID: PMC8523189 DOI: 10.1259/bjr.20201220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: With the increasing recognition of gastrointestinal (GI) manifestation of coronavirus disease-19 (COVID-19), various abdominal imaging findings are increasingly being noted. We scoped the existing literature on the abdominal imaging findings in COVID-19. Methods: A systematic literature search was performed on PubMed, Embase, Google scholar and World Health Organization COVID-19 database. Results: 35 studies were included in the final descriptive synthesis. Among the studies reporting positive abdominal imaging findings in patients with COVID-19, majority described imaging abnormalities of the GI tract (16 studies), of which bowel wall thickening was most frequently reported. Other findings noted were abdominal imaging manifestations of bowel ischemia with thrombosis of the splanchnic vasculature, and imaging features suggestive of pancreatitis. Imaging findings suggestive of solid organ infarction were reported in nine studies. An association between imaging evidence of hepatic steatosis and COVID-19 was noted in three studies. Incidental lung base findings on abdominal imaging were noted in 18 studies, where patients presented with predominant GI symptoms. The most common finding was bilateral ground glass opacities (90.7%) with predominant multilobar (91.1%) and peripheral (64.4%) distribution. Conclusion: This systematic review provides insight into the abdominal imaging findings in patients with COVID-19. Knowledge of these imaging manifestations will not only help in further research but also will aid in curtailing transmission of the SARS-CoV-2. Further prospective studies are needed to gain better insight into the pathophysiology of these imaging manifestations. Advances in knowledge: This review highlights the abdominal imaging findings in patients with COVID-19, to gain insight into the disease pathophysiology and gear the abdominal radiologist through the pandemic.
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Affiliation(s)
- Lokesh Agarwal
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ayushi Agarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shailesh Advani
- Department of Oncology, Lombardi Comprehensive cancer Center, Georgetown University, Washington, DC, Washington, DC, USA
| | - Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Aprajita Chaturvedi
- Department of Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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23
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ALKAN S, YILMAZ M, UYAR C, YILDIRIM A, DİNDAR DEMİRAY EK. COVID 19 Pnömonisi Olan Bir Hastada Olası Akut Pankreatit. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.887354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
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Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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25
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Jabłońska B, Olakowski M, Mrowiec S. Association between acute pancreatitis and COVID-19 infection: What do we know? World J Gastrointest Surg 2021; 13:548-562. [PMID: 34194613 PMCID: PMC8223709 DOI: 10.4240/wjgs.v13.i6.548] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/25/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also called coronavirus disease 2019 (COVID-19), first originated in Wuhan, China, displaying atypical pneumonia-like respiratory symptoms in affected patients. SARS-CoV-2 primarily attacks the respiratory system, and the most common symptoms include cough, shortness of breath, and fever. However, its impact on the digestive system has been shown, and various clinical gastrointestinal manifestations of this disease have been recognized. Some reports have shown acute pancreatitis (AP) as the initial symptom in patients with COVID-19. AP may be a consequence of direct pancreatic damage by the virus because pancreatic acinar cells contain angiotensin-converting enzyme 2 receptor proteins, and SARS-CoV-2 can bind to these receptors, causing pancreatic injury. Moreover, AP may be a secondary indicator of cytokine storms and altered inflammatory responses. Our review of the literature shows that SARS-CoV-2 appears to be a new etiological infectious factor related to AP. In this manuscript, a comprehensive review of case reports and case series of patients with AP and COVID-19 is presented. All reports on COVID-19-associated AP are summarized. All cases are thoroughly analyzed and discussed in-depth.
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Affiliation(s)
- Beata Jabłońska
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice 40-752, Poland
| | - Marek Olakowski
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice 40-752, Poland
| | - Sławomir Mrowiec
- Department of Digestive Tract Surgery, Medical University of Silesia, Katowice 40-752, Poland
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26
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Arche Banzo MJ, Matute Guerrero A, Herrero García S. Acute necro-hemorrhagic pancreatitis during SARS-CoV-2 infection. Med Clin (Barc) 2021; 158:346-347. [PMID: 34226057 PMCID: PMC8253662 DOI: 10.1016/j.medcli.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023]
Affiliation(s)
- María José Arche Banzo
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | | | - Sandra Herrero García
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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27
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Chandra R, Lazar NJ, Goldman S, Imam Z, Mansour R. Novel Coronavirus (COVID-19) Infection-Attributed Acute Pancreatitis: A Case Report and Literature Review. Cureus 2021; 13:e15725. [PMID: 34295577 PMCID: PMC8290904 DOI: 10.7759/cureus.15725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 01/09/2023] Open
Abstract
Novel coronavirus (COVID-19) has spread widely across the world inducing a global health crisis. Predominant signs of infection involve respiratory symptoms such as cough and dyspnea. Investigation into COVID-19 infection-associated gastrointestinal symptoms remains fluid. COVID-19-induced acute pancreatitis has been recorded from greater than 20 countries at this time. Herein, we submit a case of COVID-19-attributed acute pancreatitis, as well as a comprehensive assessment of previously reported cases of COVID-19-attributed acute pancreatitis.
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Affiliation(s)
| | | | - Seth Goldman
- Internal Medicine, Beaumont Health, Royal Oak, USA
| | - Zaid Imam
- Gastroenterology, Beaumont Medical Center, Royal Oak, USA
| | - Ramy Mansour
- Gastroenterology, Endoscopic Solutions PC, Clarkston, USA
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28
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Saeed GA, Helali AAA, Shah A, Almazrouei S, Ahmed LA. Chest CT performance and features of COVID-19 in the region of Abu Dhabi, UAE: a single institute study. ACTA ACUST UNITED AC 2021; 4:248-256. [PMID: 34179688 PMCID: PMC8211305 DOI: 10.1007/s42058-021-00075-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 04/14/2021] [Accepted: 06/07/2021] [Indexed: 01/08/2023]
Abstract
Objective We aim to investigate high-resolution CT features of COVID-19 infection in Abu Dhabi, UAE, and to compare the diagnostic performance of CT scan with RT-PCR test. Methods Data of consecutive patients who were suspected to have COVID-19 infection and presented to our hospital were collected from March 2, 2020, until April 12, 2020. All patients underwent RT-PCR test; out of which 53.8% had chest CT scan done. Using RT-PCR as a standard reference, the sensitivity and specificity of the CT scan were calculated. We also analyzed the most common imaging findings in patients with positive RT-PCR results. Results The typical HRCT findings were seen in 50 scans (65.8%) out of total positive ones; 44 (77.2%) with positive RT-PCR results and 6 (31.6%) with negative results. The peripheral disease distribution was seen in 86%, multilobe involvement in 70%, bilateral in 82%, and posterior in 82% of the 50 scans. The ground glass opacities were seen in 50/74 (89.3%) of the positive RT-PCR group. The recognized GGO patterns in these scans were: rounded 50%, linear 38%, and crazy-paving 24%. Using RT-PCR as a standard of reference, chest HRCT scan revealed a sensitivity of 68.8% and specificity of 70%. Conclusion The commonest HRCT findings in patients with COVID-19 pneumonia were peripheral, posterior, bilateral, multilobe rounded ground-glass opacities. The performance of HRCT scan can vary depending on multiple factors.
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Affiliation(s)
| | | | - Asad Shah
- General Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | - Luai A Ahmed
- Institute of Public Health, College of Medicine & Health Sciences, UAE University, Al Ain, UAE
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29
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Kanne JP, Bai H, Bernheim A, Chung M, Haramati LB, Kallmes DF, Little BP, Rubin GD, Sverzellati N. COVID-19 Imaging: What We Know Now and What Remains Unknown. Radiology 2021; 299:E262-E279. [PMID: 33560192 PMCID: PMC7879709 DOI: 10.1148/radiol.2021204522] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infection with SARS-CoV-2 ranges from an asymptomatic condition to a severe and sometimes fatal disease, with mortality most frequently being the result of acute lung injury. The role of imaging has evolved during the pandemic, with CT initially being an alternative and possibly superior testing method compared with reverse transcriptase-polymerase chain reaction (RT-PCR) testing and evolving to having a more limited role based on specific indications. Several classification and reporting schemes were developed for chest imaging early during the pandemic for patients suspected of having COVID-19 to aid in triage when the availability of RT-PCR testing was limited and its level of performance was unclear. Interobserver agreement for categories with findings typical of COVID-19 and those suggesting an alternative diagnosis is high across multiple studies. Furthermore, some studies looking at the extent of lung involvement on chest radiographs and CT images showed correlations with critical illness and a need for mechanical ventilation. In addition to pulmonary manifestations, cardiovascular complications such as thromboembolism and myocarditis have been ascribed to COVID-19, sometimes contributing to neurologic and abdominal manifestations. Finally, artificial intelligence has shown promise for use in determining both the diagnosis and prognosis of COVID-19 pneumonia with respect to both radiography and CT.
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Affiliation(s)
- Jeffrey P. Kanne
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Harrison Bai
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Adam Bernheim
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Michael Chung
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Linda B Haramati
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - David F. Kallmes
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Brent P. Little
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Geoffrey D. Rubin
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
| | - Nicola Sverzellati
- From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.)
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Abstract
BACKGROUND The data on clinical course and outcome of acute pancreatitis among patients with coronavirus disease 2019 (COVID-19) are sparse. In this study, we analyzed the clinical profiles of patients with COVID 19 and acute pancreatitis. METHODS This retrospective study was conducted on Research Patient Data Registry data which was pooled from five Mass General Brigham Healthcare Network hospitals. We extracted data on demographics, symptoms, ICU transfer, mechanical ventilation, laboratories' profiles, imaging findings, and patient outcomes. RESULT Of 985 screened adult patients, 17 were eligible for the study, 9 (52.9%) were admitted primarily for respiratory failure and developed acute pancreatitis after a median of 22.5 days (13-76 days) from the onset of COVID-19 symptoms. On contrary, eight patients presented with typical symptoms and were diagnosed with acute pancreatitis, the majority with mild severity (62.5%) on admission. Patients who were admitted primarily with severe COVID-19 illness were younger (median age 57 vs. 63 years), females (55.6 vs. 25%), of Hispanic ethnicity (55.6 vs. 25%), and obese (88.9 vs. 37.5%). The median peak lipase, C reactive protein, ferritin, lactate dehydrogenase, D-dimer were higher among patients who developed acute pancreatitis later during hospitalization. Patients who developed acute pancreatitis later also experienced higher episodes of necrotizing pancreatitis (11.1% vs. 0), thromboembolic complications (55.6 vs. 12.5%), and higher mortality (37.5 vs. 12.5%). CONCLUSION Acute pancreatitis is not common among patients with COVID-19. Patients with COVID-19 who had acute pancreatitis on admission had more benign course and overall better outcome as compared to the patients who developed acute pancreatitis during hospitalization.
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31
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DİNDAR DEMİRAY EK, YILMAZ M, ALIRAVCI ID, ALKAN S. COVID-19-Akut Pankreatit İlişkisinin İncelenmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.815768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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32
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Khan FY, Sulaiman TO, Nair AP, Osman ME. Coronavirus Disease-19-associated Acute Pancreatitis: Report of Three Cases and Review of Case Reports. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis continue to emerge. In this series, we present three cases of acute pancreatitis associated with COVID-19 with no obvious etiology.
CASE REPORTS: The first case was a 47-year-old man who presented with severe abdominal periumbilical pain, preceded by fever and dry cough. Based on a positive COVID-19 polymerase chain reaction (PCR) test and elevated serum amylase and lipase >3 times the upper normal limit, the diagnosis of COVID-19 and acute pancreatitis were established. The next case was a 57-year-old man with confirmed COVID-19 who developed severe epigastric pain radiating to the back and was associated with nausea and vomiting. His serum amylase and lipase were elevated >3 times the upper normal limit confirming the diagnosis of acute pancreatitis. The third case was a 31-year-old man who presented to the emergency department with a few hours of severe epigastric pain radiating to the back associated with nausea and vomiting. Two days before his presentation, he had a runny nose and fever. A combination of serum amylase and lipase elevation, >3 times the upper normal limits, and a positive COVID-19 PCR test were obtained concurrently, confirming the diagnosis of COVID-19 associated acute pancreatitis. All patients were admitted to the Mesaieed Hospital COVID-19 facility and received treatment for COVID-19 according to our local guidelines, while acute pancreatitis was treated conservatively. All three patients were discharged in good condition.
CONCLUSION: This case series suggests a possible correlation between COVID-19 and acute pancreatitis.
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Abstract
The clinical manifestations of SARS-CoV-2 infection, the causative agent of COVID-19, mainly involve the respiratory system. However, there is increasing evidence that this virus can affect other organs causing a wide arrange of clinical symptoms. In this report, we present the case of 14-year-old boy with acute abdominal pain, with laboratory and radiologic findings consistent with acute pancreatitis, without any risk factors except for a SARS-CoV-2 infection.
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Affiliation(s)
| | | | | | - Erick F Mayer
- Department of Pediatrics
- Department of Research, Serveis Integrats de Salut Baix Empordà, Girona, Spain
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34
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AlHarmi RAR, Fateel T, Sayed Adnan J, AlAwadhi K. Acute pancreatitis in a patient with COVID-19. BMJ Case Rep 2021; 14:e239656. [PMID: 33574045 PMCID: PMC7880111 DOI: 10.1136/bcr-2020-239656] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/09/2023] Open
Abstract
COVID-19 mainly causes pulmonary disease. Involvement of gastrointestinal and hepatobiliary systems, among other systems, has been reported. We report a case of acute pancreatitis in a patient with resolving COVID-19 pneumonia. History taking and investigations excluded other causes of pancreatitis. This case demonstrates the possibility of pancreatic injury in patients with COVID-19, in line with previously reported similar cases. We believe that it is imperative to screen patients presenting with acute pancreatitis for SARS-CoV-2. It is also important to take into consideration that patients with a complicated course who require an invasive procedure such as drainage might pose a risk of transmission to the operating surgeon or interventionist.
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Affiliation(s)
| | - Tahera Fateel
- Department of Surgery, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Kamel AlAwadhi
- Department of Surgery, Salmaniya Medical Complex, Manama, Bahrain
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35
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Samanta J, Gupta R, Singh MP, Patnaik I, Kumar A, Kochhar R. Coronavirus disease 2019 and the pancreas. Pancreatology 2020; 20:1567-1575. [PMID: 33250089 PMCID: PMC7550073 DOI: 10.1016/j.pan.2020.10.035] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/12/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led to a world-wide pandemic since its onset in December of 2019. Although, a primary respiratory pathogen, over the ensuing period, its extra-pulmonary effects have come to the forefront. The virus, having multi-organ tropism, has been shown to affect a host of other organs beyond the lung, including the pancreas. The data on pancreatic involvement by COVID-19, however, have been limited. Moreover, whether the effects on the pancreas are due to the direct effects of the virus or is just an epi-phenomenon is debatable. The prevalence of pancreatic injury and degree of injury are the other issues that need to be addressed. Pancreatic cancer has a dismal prognosis and the management of the same in the COVID era needs to be tailored assessing the risk-benefit ratio for the same. Additionally, pancreatic surgery increases not only the morbidity of the patient, but also the risk of the operator and burden on the health care system. Hence, the decision for such major procedures needs to be rationalized for optimum benefit during this pandemic. Similarly, for the endoscopist, pancreatic endoscopy needs to be carefully regulated to reduce risk to both the patient and the physician and yet deliver optimum patient care. This review gives a concise summary of various aspects of pancreatic involvement and pancreatic disease management during this pandemic.
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Affiliation(s)
| | - Rohit Gupta
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Itish Patnaik
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Ashok Kumar
- Department of Gastroenterology, AIIMS, Rishikesh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India.
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Alharthy A, Balhamar A, Faqihi F, Nasim N, Noor A, Alqahtani S, Memish Z, Karakitsos D. Rare case of COVID-19 presenting as acute abdomen and sepsis. New Microbes New Infect 2020; 38:100818. [PMID: 33224507 PMCID: PMC7670919 DOI: 10.1016/j.nmni.2020.100818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) may present as acute abdomen, although the pathophysiology remains obscure. We report the case of a 45-year-old-man with severe COVID-19 pneumonia with associated pulmonary embolism who presented with acute abdomen. He underwent emergency laparotomy and resection of an ischaemic area of the jejunum. Postoperatively, he had septic shock, acute respiratory distress syndrome and acute kidney injury necessitating continuous renal replacement therapy. We administered antibiotics and therapeutic anticoagulation along with two sessions of haemoadsorption by CytoSorb filter, in conjunction with continuous renal replacement therapy. The patient survived. Bowel ischaemia due to thromboembolic disease should be promptly treated. Extracorporeal blood purification may be useful in managing sepsis in severe COVID-19.
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Affiliation(s)
- A. Alharthy
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - A. Balhamar
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - F. Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - N. Nasim
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - A.F. Noor
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - S.A. Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, MD, USA
| | - Z.A. Memish
- Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia
| | - D. Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Corresponding author: D. Karakitsos, Critical Care Department, PO Box 331905, King Saud Medical City, 11373 Shemaisi, Riyadh, Saudi Arabia.
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Cheung S, Delgado Fuentes A, Fetterman AD. Recurrent Acute Pancreatitis in a Patient with COVID-19 Infection. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e927076. [PMID: 32833954 PMCID: PMC7476744 DOI: 10.12659/ajcr.927076] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Male, 38-year-old Final Diagnosis: Recurrent idiopathic acute pancreatitis with COVID-19 Symptoms: Nausea • severe abdominal pain • fever • vomiting Medication:— Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases • General and Internal Medicine
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Affiliation(s)
- Szeya Cheung
- Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA
| | | | - Alan D Fetterman
- Department of Internal Medicine, Long Island Community Hospital, Patchogue, NY, USA
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