S1532 Gastrointestinal Manifestation of COVID-19: A Case Report Describing Acute Pancreatitis in the Setting of SARS-CoV-2

INTRODUCTION: Over seven million cases of Coronavirus Disease 2019 (COVID-19) have been confirmed thus far with over four hundred thousand deaths (1) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 with a spectrum of disease severity with pneumonia being the most common manifestation Studies have shown SARS-CoV-2 inducing damage to heart, kidney and pulmonary tissue through possible binding of the ACE2 receptor (10) As the incidence of COVID-19 cases increase, there is increased reporting of gastrointestinal manifestations In view of this, we report a case of COVID-19 induced pancreatitis CASE DESCRIPTION/METHODS: 69-year-old lady initially admitted for respiratory failure in the setting of SARS-CoV-2 pneumonia presents 3 days after discharge with epigastric pain Her medical history significant for a prior cholecystectomy Patient never smoked, drank alcohol, or used illicit drugs Labs and imaging significant for leukocytosis, mildly elevated lipase, and CT abdomen suggestive of acute pancreatitis Given her findings, she was diagnosed with mild acute pancreatitis She was volume resuscitated, pain managed with hydromorphone, and started on early parenteral nutrition She tolerated a diet by hospital day 5 and discharged home DISCUSSION: Diagnosis of acute pancreatitis is met when patients fulfill two of the following criteria: typical symptoms, lipase/amylase three times the upper limit of normal, or imaging findings consistent with acute pancreatitis In our case presentation, our patient met the criteria confirming the diagnosis In regards to the etiology, a comprehensive evaluation found no particular etiology for our patient's pancreatitis However, viruses can be a potential cause of acute pancreatitis Previous theories suggest direct destruction of pancreatic acinar cells via inflammation and edema particularly in HBV induced pancreatitis We suggest there may be a similar state of inflammation occurring from coronavirus infection It is speculated SARS-CoV-2 may use its spike (S) protein to bind angiotensin-converting enzyme 2 (ACE2) on the host cell membrane to gain entry into the cell (14) Liu et al showed expression of ACE2 in both exocrine gland and islets of the pancreas At this time, pathogenesis remains unclear, but one can extrapolate SARS-CoV-2 may induce pancreatitis due to direct cytopathic effects of viral entry and replication As COVID-19 pandemic continues, it would be worthwhile to suspect SARS-CoV-2 as an etiology of acute pancreatitis