key: cord-0742987-xhq9runj
authors: Amé, Ricardo Martín; Balderramo, Domingo
title: Is necessary to rule out Severe Acute Respiratory Syndrome Coronavirus 2 infection in every patient admitted for acute pancreatitis?
date: 2021-05-21
journal: Gastroenterol Hepatol
DOI: 10.1016/j.gastrohep.2021.02.021
sha: dca193d6a2a3a37cdc9228107127718b294ba78c
doc_id: 742987
cord_uid: xhq9runj

nan

J o u r n a l P r e -p r o o f Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can present several gastrointestinal manifestations (1, 2) . Cases of acute pancreatitis (AP) have been reported in patients with severe respiratory manifestations associated to SARS-CoV-2 (3) . However, there are few publications of AP as the main manifestation of infection (4) .

Also, the period between SARS-CoV-2 infection diagnosis and AP presentation and the role of possible risk factors are not well established (1).

We report two cases of AP as the main manifestation of SARS-CoV-2 infection with different presentation after infection diagnosis. Different series have shown that about 10% of patients with severe SARS-CoV-2 pneumonia may present elevated pancreatic enzymes or AP (4). However, in some studies only the increase in pancreatic enzymes was evaluated without considering the presence of characteristic abdominal pain or imaging findings (1) . In the present cases, AP was considered according to the Atlanta classification including clinical, laboratory and radiological criteria (5) . Differently from the present reported cases, a great proportion of cases of AP related to SARS-CoV-2 infection published were of mild severity and in the context of a moderate-severe respiratory involvement of thoracic CT exams (3, 4) .

Both patients had no history of AP and the etiological study was negative for gallstones, toxics, high values of triglycerides or calcium, or trauma. Furthermore, none of the patients had previously consumed any medication other than their usual medication. A limitation of the present report is that endoscopic ultrasound was not available, therefore microlithiasis cannot be fully excluded as etiology. However, this cause is unlikely as liver enzymes were normal during admission and MRCP did not show biliary abnormalities.

AP was presented at the same time of SARS-CoV-2 infection diagnosis in one case.

In the other case, AP was diagnosed almost at the second week of the infection, which was asymptomatic until that moment. This difference could be due to other unknown mechanisms, as active smoking, that may present a role on the development of AP in the context of SARS-CoV-2 infection.

In conclusion, we report two cases of AP as the main manifestation of SARS-CoV-2 infection with a different temporal relationship between the infection and the clinical presentation of AP. In this current epidemiological context, all patients admitted for a diagnosis of AP should be evaluated for SARS-CoV-2 infection, regardless of the presence of fever or respiratory symptoms. 

SARS-CoV-2 and acute pancreatitis: a new etiological agent?

COVID-19 and acute pancreatitis: examining the causality

COVID-19 presenting as acute pancreatitis

Emerging Phenotype of Severe Acute Respiratory Syndrome-Coronavirus 2-associated Pancreatitis

Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus