• COVID-19
• immune cells
• multiple organs
• post-COVID-19
• vitamin D

• Humans
• COVID-19/immunology
• Vitamin D
• Vitamin D Deficiency/immunology
• Vitamin D Deficiency/complications
• SARS-CoV-2/immunology
• Dietary Supplements

• COVID-19
• SARS-CoV-2
• endosomal entry
• hyperglycemia
• membrane fusion
• new-onset diabetes
• pancreatic β-cells

• Insulin-Secreting Cells/virology
• Insulin-Secreting Cells/metabolism
• Humans
• Hyperglycemia/virology
• Hyperglycemia/metabolism
• Hyperglycemia/complications
• SARS-CoV-2/physiology
• COVID-19/virology
• COVID-19/complications
• COVID-19/metabolism
• Virus Internalization
• Spike Glycoprotein, Coronavirus/metabolism
• Diabetes Mellitus/virology
• Diabetes Mellitus/metabolism

• NA South African Medical Research Council
• NA Stellenbosch University

• Acute pancreatitis
• Angiotensin-converting enzyme-2 receptor
• COVID-19
• Immunosuppressive agents
• Kidney transplant

• COVID-19
• Complications
• Mortality
• National inpatient sample
• Pancreatitis
• United States

• Humans
• United States/epidemiology
• Pancreatitis/etiology
• Inpatients
• COVID-19/epidemiology
• COVID-19/therapy
• COVID-19/complications
• Acute Disease
• Shock, Septic/complications
• SARS-CoV-2
• Acute Kidney Injury/etiology

• COVID-19
• SARS-CoV-2
• autoimmune
• molecular mechanisms
• type 1 diabetes
• viral infections

• Humans
• COVID-19/complications
• Diabetes Mellitus, Type 1/epidemiology
• Diabetes Mellitus, Type 1/etiology
• SARS-CoV-2
• Pandemics
• Islets of Langerhans

• acute pancreatitis
• severe acute respiratory syndrome coronavirus 2 infection
• vaccine

• Acute kidney injury
• Acute pancreatitis
• COVID-19
• Diabetes
• Diabetic ketoacidosis
• Healthcare
• SARS coronavirus

• COVID-19
• Infections
• Pancreatic diseases
• Pancreatitis
• Post-acute COVID-19 syndrome

• Humans
• Adolescent
• Young Adult
• Adult
• Middle Aged
• Aged
• Aged, 80 and over
• COVID-19/complications
• COVID-19/diagnosis
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Retrospective Studies
• Acute Disease
• Gallstones

• Acute pancreatitis
• COVID-19
• pleural effusion
• prognostic analysis

• ACE-2
• COVID-19
• MDSCs
• SARS-CoV-2
• autophagy
• cytokine storm
• gastrointestinal tract
• inflammation
• intestine
• liver
• pancreas

• Humans
• COVID-19
• SARS-CoV-2
• Liver
• Intestines
• Pancreas

• P20 GM121288 NIGMS NIH HHS
• P30 GM114732 NIGMS NIH HHS

• Acute pancreatitis
• COVID-19
• Hyperlipidemia
• Pancreatic injury
• SARS-CoV-2

• Acute Disease
• COVID-19/complications
• Humans
• Hyperlipidemias/complications
• Hyperlipidemias/epidemiology
• Pancreatitis/etiology
• SARS-CoV-2

• Acute Disease
• Adult
• COVID-19/complications
• Critical Illness
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis/epidemiology
• SARS-CoV-2

• SARS-CoV-2 infection
• anti-glycating agent
• carnosine
• diabetes
• long COVID

• Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro
• Conselho Nacional de Desenvolvimento Científico e Tecnológico

• COVID-19
• Etiology
• Pancreatitis
• Prognosis
• Revised atlanta classification
• SARS-CoV-2

• Acute Disease
• COVID-19/complications
• Child
• Humans
• Pancreas
• Pancreatitis
• SARS-CoV-2

• SARS-CoV-19
• antiinflammatory
• flavonoids
• post-COVID-19 syndrome

• lipase
• acute pancreatitis
• covid-19
• sars-cov-2

• Acute Disease
• Adult
• COVID-19
• Humans
• Pancreatitis
• Prospective Studies
• Retrospective Studies
• SARS-CoV-2

• Severe acute pancreatitis
• glutamine
• liver function
• ulinastatin

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.

Background

This study investigates the relationship between coronavirus disease 2019 (COVID-19) infection and acute pancreatitis. We present large registry data assessing the association between acute pancreatitis and mortality in patients with COVID-19 post-infection.

Methods

The researchers identified adult patients aged 18-90 years with COVID-19 infections in the TriNetX (COVID-19 research network) database between January 20, 2020, and June 1, 2021. The researchers identified n=1,039,688 cases divided into two cohorts: those with post-acute pancreatitis (n= 1,173) and those without post-acute pancreatitis (n=1,038,515) post COVID-19 infection having follow-up within a two-week period. The researchers then conducted a 1:1 propensity score match to account for differences in the cohorts and created two well-matched cohorts (n=1,173/1,173).

Results

Patients that developed acute pancreatitis had higher mortality (12.4% vs 3.7%, p<0.001), stroke (3.6% vs 1.7%, p=0.005), higher inpatient admissions (28.2% vs 10.6%, p<0.001), and higher rates of ICU admission (9.5% vs 3.2%, p<0.001).

Conclusion

In a large multinational federated database, we observed higher mortality, stroke, higher inpatient admissions, and higher rates of ICU admissions among patients with COVID-19 with pancreatitis.

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.

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.

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.

The consequences of the coronavirus disease 2019 pandemic have already exceeded 10 million infected and more than 560,000 deaths worldwide since its inception. Currently, it is known that the disease affects mainly the respiratory system; however, recent studies have shown an increase in the number of patients with manifestations in other systems, including gastrointestinal manifestations. There is a lack of literature regarding the development of acute pancreatitis as a complication of coronavirus disease 2019.

We report a case of acute pancreatitis in a white male patient with coronavirus disease 2019. A 35-year-old man (body mass index 31.5) had acute epigastric pain radiating to his back, dyspnea, nausea, and vomiting for 2 days. The patient was diagnosed with severe acute pancreatitis (AP)-APACHE II: 5, SOFA: 3, Marshall: 0; then he was transferred from ED to the semi-intensive care unit. He tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription-polymerase chain reaction, and his chest computed tomography findings were compatible with coronavirus disease 2019. Treatment was based on bowel rest, fluid resuscitation, analgesia, and empiric antibiotic therapy. At day 12, with resolution of abdominal pain and improvement of the respiratory condition, the patient was discharged.

Since there is still limited evidence of pancreatic involvement in severe acute respiratory syndrome coronavirus 2 infection, no definite conclusion can be made. Given the lack of other etiology, we consider the possibility that the patient’s acute pancreatitis could be secondary to coronavirus disease 2019 infection, and we suggest investigation of pancreas-specific plasma amylase in patients with coronavirus disease 2019 and abdominal pain.

• Acute pancreatitis
• Case report
• Pancreatic involvement in COVID-19
• Pancreatitis in COVID-19

• COVID-19
• SARS-CoV-2
• amylase
• cytokines
• lipase
• pancreas
• pancreatitis

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.

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.

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.

• Acute pancreatitis
• COVID-19
• Case report
• Pancreas
• SARS-CoV-2

• Abdominal imaging
• Computed tomography
• Gastrointestinal
• Radiology

Evidence suggests an association between severe acute respiratory syndrome–cornavirus-2 (SARS-CoV-2) infection and the occurrence of new-onset diabetes. We examined pancreatic expression of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2), the cell entry factors for SARS-CoV-2, using publicly available single-cell RNA sequencing data sets, and pancreatic tissue from control male and female nonhuman primates (NHPs) and humans. We also examined SARS-CoV-2 immunolocalization in pancreatic cells of SARS-CoV-2–infected NHPs and patients who had died from coronavirus disease 2019 (COVID-19). We report expression of ACE2 in pancreatic islet, ductal, and endothelial cells in NHPs and humans. In pancreata from SARS-CoV-2–infected NHPs and COVID-19 patients, SARS-CoV-2 infected ductal, endothelial, and islet cells. These pancreata also exhibited generalized fibrosis associated with multiple vascular thrombi. Two out of 8 NHPs developed new-onset diabetes following SARS-CoV-2 infection. Two out of 5 COVID-19 patients exhibited new-onset diabetes at admission. These results suggest that SARS-CoV-2 infection of the pancreas may promote acute and especially chronic pancreatic dysfunction that could potentially lead to new-onset diabetes.

• COVID-19
• Diabetes
• Endothelial cells
• Thrombosis

• COVID-19
• amylase
• lipase
• pancreatitis
• pandemic

• COVID
• SARS-CoV-2
• beta cell
• diabetes
• islet

• Bystander Effect/physiology
• COVID-19/complications
• COVID-19/epidemiology
• COVID-19/metabolism
• COVID-19/physiopathology
• Cytokine Release Syndrome/complications
• Cytokine Release Syndrome/immunology
• Cytokine Release Syndrome/metabolism
• Cytokine Release Syndrome/virology
• Diabetes Mellitus/immunology
• Diabetes Mellitus/metabolism
• Diabetes Mellitus/virology
• Humans
• Inflammation/complications
• Inflammation/metabolism
• Inflammation/virology
• Insulin Resistance/physiology
• Insulin-Secreting Cells/physiology
• Insulin-Secreting Cells/virology
• Pandemics
• SARS-CoV-2/pathogenicity
• SARS-CoV-2/physiology

• R01 DK121929 NIDDK NIH HHS
• F30 DK122681 NIDDK NIH HHS
• U01 DK127786 NIDDK NIH HHS
• T32 DK064466 NIDDK NIH HHS
• T32 GM077229 NIGMS NIH HHS
• R03 DK117253 NIDDK NIH HHS

Abdominal pain, nausea, and vomiting are known gastrointestinal symptoms of symptomatic SARS-CoV-2 infection (COVID-19 disease) in pediatric patients.¹ There is little literature regarding pancreatitis in COVID-19. We describe a 16-year-old male diagnosed with acute pancreatitis in the setting of a SARS-COV-2 infection and associated fluid balance considerations.

• SARS-CoV-2
• acute pancreatitis
• pediatrics

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the ongoing pandemic of coronavirus disease 2019 (COVID-19), and has caused more than 80 million infections and 1.7 million deaths worldwide. Although it is primarily a respiratory virus, SARS-CoV-2 also has extra-pulmonary effects. Pancreatic injury and cases of acute pancreatitis (AP) have been recognized and attributed to SARS-CoV-2, but the mechanisms of pancreatic injury are still a subject of debate. There is also controversy on whether SARS-CoV-2 can cause AP or if it is an epiphenomenon.

To review and to explore the relationship between SARS-CoV-2 infection and AP, and to provide an overview of the existing literature on possible mechanisms of SARS-CoV-2-induced pancreatic lesion.

A systematic review was conducted in accordance with PRISMA guidelines for papers on SARS-CoV-2 infection and AP. A narrative review on possible mechanisms of SARS-CoV-2-induced pancreatic lesion was also performed.

A literature review revealed a growing body of evidence on SARS-CoV-2-induced pancreatic lesions including the mechanisms of direct virus-mediated injury, systemic inflammatory response and circulating pro-inflammatory interleukins, virus-induced lipotoxicity, and drug-induced injury. A systematic review of the literature revealed 22 cases of AP in COVID-19 patients. However, limitations of the reported cases make it difficult to establish a causal relationship between SARS-CoV-2 infection and AP. All of the studies agreed on special monitoring and surveillance of this subset of patients due to the still unknown clinical progression, therapeutic implications, and prognosis.

AP should be considered in COVID-19 patients, especially in those exhibiting abdominal pain and systematic, and complete reporting of these cases should be general practice. However, there is still insufficient evidence showing that COVID-19 can cause AP or negatively impact prognosis. Additional studies are needed to clarify the relationship between these two entities and their theragnostic significance.

• Pancreatitis
• Pancreas
• COVID-19
• SARS-CoV-2

• Acute pancreatitis
• Angiotensin-converting enzyme 2
• COVID-19
• SARS-CoV-2

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.

• acute pancreatitis
• atlanta classification
• covid-19
• sars-cov-2
• viral pancreatitis

• COVID-19
• acute pancreatitis
• pancreatitis

• COVID-19/diagnosis
• COVID-19/epidemiology
• Cohort Studies
• Comorbidity
• Disease Progression
• Female
• Humans
• Intensive Care Units/statistics & numerical data
• International Cooperation
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Mortality
• Organ Dysfunction Scores
• Outcome Assessment, Health Care
• Pancreatitis/diagnosis
• Pancreatitis/mortality
• Pancreatitis/physiopathology
• Respiratory Distress Syndrome/diagnosis
• Respiratory Distress Syndrome/etiology
• SARS-CoV-2/isolation & purification
• Severity of Illness Index

• 11883 Cancer Research UK
• 16186 Cancer Research UK
• 16812 Cancer Research UK
• 17680 Cancer Research UK
• 15957 Cancer Research UK
• 8968 Cancer Research UK
• 15/20/01 Department of Health
• 08/29/02 Department of Health
• AUGIS
• PSGBI

Coronavirus disease 2019 (COVID‐19), caused by coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has caused extensive disruption and mortality since its recent emergence. Concomitantly, there has been a race to understand the virus and its pathophysiology. The clinical manifestations of COVID‐19 are manifold and not restricted to the respiratory tract. Extrapulmonary manifestations involving the gastrointestinal tract, hepatobiliary system, cardiovascular and renal systems have been widely reported. However, the pathophysiology of many of these manifestations is controversial with questionable support for direct viral invasion and an abundance of alternative explanations such as pre‐existing medical conditions and critical illness. Prior research on SARS‐Co‐V and NL63 was rapidly leveraged to identify angiotensin‐converting enzyme 2 (ACE2) receptor as the key cell surface receptor for SARS‐CoV‐2. The distribution of ACE2 has been used as a starting point for estimating vulnerability of various tissue types to SARS‐CoV‐2 infection. Sophisticated organoid and animal models have been used to demonstrate such infectivity of extrapulmonary tissues in vitro, but the clinical relevance of these findings remains uncertain. Clinical autopsy studies are typically small and inevitably biased towards patients with severe COVID‐19 and prolonged hospitalization. Technical issues such as delay between time of death and autopsy, use of inappropriate antibodies for paraffin‐embedded tissue sections and misinterpretation of cellular structures as virus particles on electron micrograph images are additional problems encountered in the extant literature. Given that SARS‐CoV‐2 is likely to circulate permanently in human populations, there is no doubt that further work is required to clarify the pathobiology of COVID‐19.

• COVID-19
• SARS-CoV-2
• pathophysiology
• transmission

Background and objective

The novel coronavirus disease 2019 (COVID-19) primarily affects the lungs. However, others organs are also affected in varying degrees. We aimed to investigate the changes in pancreatic density on CT and its correlation with amylase/lipase values in patients diagnosed with COVID-19.

Materials and methods

Radiological changes using non-contrast CT and amylase/lipase values were evaluated retrospectively in patients admitted to the pandemic clinic. The patients were classified into two groups: [polymerase chain reaction (PCR)-positive and PCR-negative]. The correlation and difference between the data were evaluated statistically.

Results

There was no significant difference with respect to age and gender between the two groups (PCR-positive and PCR-negative). There was a significant difference in the head, neck, trunk, and tail of the pancreas and mean density values, but no statistically significant difference in amylase and lipase values between the two groups. No significant correlation was found using Spearman’s correlation test.

Conclusion

Based on our findings, pancreatic involvement and severe necrotizing pancreatitis can be seen in COVID-19 patients. Pancreatic involvement is more common in patients with severe disease. Patients with gastrointestinal complaints should be evaluated for pancreatitis and their amylase/lipase values should be assessed. We believe that decreased pancreatic density on CT scans can be an early sign of pancreatitis.

• covid-19
• pancreas
• pancreatic ınjury
• pancreatitis
• tomography

For the first time, the mRNA technology was utilized to produce a vaccine against COVID-19 after the unprecedented pandemic equally affected every part of the world. Pfizer-BioNTech (BNT162b2) mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was granted emergency use authorization (EUA) by Food and Drug Administration (FDA) in December 2020. EUA has been widely discussed in the medical literature and the general public. The safety of the BNT162b2 vaccine has been investigated in short-term trials with data available for three months. We present a case of a 96-year-old female with a past surgical history of cholecystectomy who presented with acute onset severe abdominal pain a few days after getting the first dose of Pfizer-BioNTech COVID-19 vaccine. She was diagnosed with acute pancreatitis with a lipase level of 4036 U/L. Extensive history and investigations were unable to find any etiology. The patient was conservatively managed and discharged home without any complications. There has been some data available in medical literature showing an association between acute pancreatitis and COVID-19 infection. Trial data of Pfizer COVID-19 also shows one case of acute pancreatitis in the treatment group. There have also been individual cases of unexplained acute pancreatitis shared by medical professionals on online forums. Our main goal to write this case is to make medical literature aware of possible emerging side effects of the COVID-19 vaccine, one of such side effects being self-resolving uncomplicated acute pancreatitis.

• acute pancreatitis
• bnt162b2 mrna
• covid-19
• pfizer-biontech

With the ongoing coronavirus disease 2019 (COVID-19) pandemic, there has been an explosion of scientific literature on the clinical manifestations and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Gastrointestinal symptoms occur in 15-20% of COVID-19 patients; however, there have not been many case reports on acute pancreatitis in COVID-19 patients. The expression of ACE-2 ([angiotensin-converting enzyme 2] the host receptor for SARS-CoV-2) is very high in the pancreas, which might be a contributing factor, but the high expression is mainly localized to endocrine pancreas. This case report describes a case of a 25-year-old Indian female with COVID-19 with acute pancreatitis in the absence of any other known risk factors for pancreatitis.

• acute pancreatitis
• amylase
• coronavirus disease 2019
• covid-19
• lipase
• sars-cov-2
• viral pancreatitis

• COVID-19
• SARS-COV-2
• atherosclerosis
• diabetes

• acute recurrent pancreatitis
• covid-19
• pancreatitis

• COVID-19
• SARS-CoV-2
• acute
• angiotensin-converting enzyme
• severe pancreatitis

• COVID-19
• Complications
• Fatigue
• Long haulers
• Post-COVID syndrome
• SARS-CoV-2

• COVID-19
• SARS-CoV-2
• necrotizing pancreatitis
• pandemic

• Abdomen, Acute/virology
• Adult
• COVID-19/diagnosis
• COVID-19/diagnostic imaging
• Diagnosis, Differential
• Humans
• Male
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/diagnostic imaging
• Pancreatitis, Acute Necrotizing/virology
• SARS-CoV-2
• Tomography, X-Ray Computed

• COVID-19
• Coronavirus
• Pancreatic carcinoma
• Pancreatic transplant
• Pancreatitis

• COVID-19/complications
• Humans
• Pancreas/pathology
• Pancreatic Diseases/complications
• Pancreatic Diseases/diagnosis
• Pancreatic Diseases/therapy
• SARS-CoV-2