An unusual presentation of COVID-19: Acute pancreatitis.
An unusual presentation of COVID-19: Acute pancreatitis.
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DOI：
10.14701/ahbps.2020.24.4.539
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发表时间：
2020-11-30
期刊：
影响因子：
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通讯作者：
Kandasamy S
中科院分区：
文献类型：
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作者：
Kandasamy S
新型COVID-19感染性疾病通常表现为肺部症状，如咳嗽、呼吸急促和发热。然而，COVID-19的胃肠道表现正越来越多地被认识到并引起高度关注。我们报告一个非典型的病例急性胰腺炎的病人与SARSCoV 2感染。腹部CT扫描显示提示急性间质性水肿性胰腺炎的结果，CT严重程度指数为3。HRCT胸部显示双肺多灶性磨玻璃样阴影，CORADS评分为5分。后来，用于COVID RT-PCR的鼻拭子检测呈阳性。患者接受了补液、优化电解质平衡和吸氧等对症治疗。她顺利恢复，腹部和肺部症状逐渐消退。COVID-19的发病机制被认为是由细胞表面的血管紧张素转换酶2（ACE-2）受体介导的。作为病毒进入宿主细胞的受体的ACE-2在胰腺细胞中高度表达。到目前为止，所有报告的COVID-19胰腺炎病例均为已知的COVID-19肺炎病例，在适当的时候或在疾病恢复期间发展为急性胰腺炎或胰腺损伤。我们是第一个出现急性胰腺炎特征而没有任何肺部症状的病例，在检查中发现COVID 19呈阳性。参与急性胰腺炎管理的临床医生应了解其在COVID-19背景下的存在。需要进一步研究来确定COVID-19患者胰腺损伤的真实的患病率和临床意义。
Novel COVID-19 infectious disease typically presents with pulmonary symptoms like cough, shortness of breath, and fever. However, gastrointestinal manifestations of COVID-19 are increasingly being recognized and drawn significant attention. We report an atypical case of acute pancreatitis in a patient with SARSCoV2 infection. CT scan of the abdomen showed findings suggestive of acute interstitial edematous pancreatitis with a CT severity index was 3. HRCT chest revealed multifocal ground glass opacities in both lungs with a CORADS score of 5. Later, nasal swab for COVID RT-PCR tested positive. The patient was treated symptomatically with fluid replacement, optimization of electrolyte balance and oxygen supplementation. She had an uneventful recovery with gradual resolution of her abdominal and pulmonary symptoms. COVID-19 pathogenesis is believed to be mediated by the angiotensin converting enzyme 2 (ACE-2) receptor over the cell surface. ACE-2, which acts as a receptor for viral entry into host cells are highly expressed in pancreatic cells. All the reported cases of COVID-19 pancreatitis so far are known cases of COVID 19 pneumonia, developed acute pancreatitis or pancreatic injury in due course or during recovery of the illness. Ours is the first case to present with features of acute pancreatitis without any pulmonary symptoms, who turned out to be positive for COVID 19 during workup. Clinicians involved in the management of acute pancreatitis should be aware of its existence in the context of COVID-19. Further studies are needed to establish the real prevalence and clinical significance of pancreatic injury in COVID-19 patients.