Gadiparthi Chiranjeevi, Mohapatra Sonmoon, Kanna Sowjanya, Vykuntam Vinit, Chen William
Department of Gastroenterology and Hepatology, Saint Peter's University Hospital-Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA.
Department of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA, USA.
Transl Gastroenterol Hepatol. 2021 Oct 25;6:65. doi: 10.21037/tgh-20-234. eCollection 2021.
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.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）全球大流行主要是一种呼吸道疾病，但也有不同严重程度的胃肠道表现的报道。在COVID-19肺炎患者中，观察性研究表明，胰腺酶升高作为胰腺损伤的替代标志物，但无急性胰腺炎（AP）的证据。我们报告一例以SARS-CoV-2为可能病原体的COVID-19患者发生AP的病例，并有胰腺炎的影像学证据。我们推测在排除常见病因后，该患者的SARS-CoV-2与AP的不明原因表现存在因果关系。我们假设COVID-19中的AP可能与胰腺中作为SARS-CoV-2病毒进入结合受体的血管紧张素转换酶2（ACE 2）受体的大量表达有关，或者与胰腺的直接病毒感染有关。虽然糖尿病与AP之间似乎存在关联，但关于糖尿病在引起AP中的病因作用的现有数据非常有限。我们还建议，对于COVID-19感染患者，在诊断AP时应考虑进行腹部计算机断层扫描（CT）等影像学检查，以排除淀粉酶和脂肪酶的假阳性。
