Acute pancreatitis in a COVID-19 patient in Brazil: a case report

Abstract Background 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. Case report 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. Conclusion 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.

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Acute pancreatitis associated with severe acute respiratory syndrome coronavirus-2 infection: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-03026-7 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Abdullah S. Eldaly ◽

Ayman R. Fath ◽

Sarah M. Mashaly ◽

Muhammed Elhadi

Keyword(s):

Acute Pancreatitis ◽

Risk Factor ◽

Severe Acute Respiratory Syndrome ◽

Serum Amylase ◽

Epigastric Pain ◽

White Male ◽

Nasopharyngeal Swab ◽

Published Data ◽

Serum Lipase ◽

Pancreatic Involvement

Abstract Introduction 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. Case 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. Conclusion 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.

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SARS-CoV-2 Infection as a Cause of Acute Pancreatitis in a Child—A Case Report

Pediatric Reports ◽

10.3390/pediatric13040065 ◽

2021 ◽

Vol 13 (4) ◽

pp. 552-557

Author(s):

Natalia Kopiczko ◽

Kamila Kwiatek-Średzińska ◽

Mirosława Uścinowicz ◽

Monika Kowalczuk-Krystoń ◽

Dariusz Marek Lebensztejn

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Report ◽

The Novel ◽

Gastrointestinal Manifestations ◽

Number Of Patients ◽

Growing Body ◽

Novel Coronavirus ◽

Mild Acute Pancreatitis ◽

First Time

The novel coronavirus disease (COVID-19) was detected for the first time in China in December 2019. Soon after it was declared a pandemic. Main symptoms include fever, dyspnea, cough, muscle pain, headache, anosmia and ageusia, however a growing body of evidence shows that other organs can be affected. Gastrointestinal manifestations have been observed in a considerable number of patients and include abdominal pain, diarrhea and vomiting. The involvement of liver as well as pancreas has been also described, however there are only a few cases of acute pancreatitis reported in patients with COVID-19. Therefore, we present a case of 6-year-old child with mild acute pancreatitis and COVID-19 pneumonia.

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An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.326-327 ◽

2019 ◽

Vol 98 (8) ◽

pp. 326-327 ◽

Cited By ~ 1

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Portal Hypertension ◽

Liver Disease ◽

Epigastric Pain ◽

Umbilical Vein ◽

History Of ◽

Clinically Significant ◽

Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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SEPSIS MARKERS AND SENSITIVITY OF STAPHYLOCOCCUS AUREUS AND ESCHERICHIA COLI ISOLATES IN A GENERAL HOSPITAL SETTING

Vestnik ◽

10.53065/kaznmu.2021.86.69.013 ◽

2021 ◽

pp. 68-74

Author(s):

М.Е. Рамазанов ◽

В.Н. Сон ◽

М.Р. Рысулы ◽

С.Т. Турсуналиев ◽

Е.Б. Еспенбетов

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Hospital Setting ◽

Bloodstream Infections ◽

High Sensitivity ◽

Clinical Isolates ◽

Empiric Antibiotic Therapy ◽

E Coli ◽

Number Of Patients ◽

Empiric Antibiotic

Представлены результаты проспективного обследования 80 больных ГКБ №7 с бактериемией с октября 2019 года по февраль 2021 года из различных отделений госпиталя. Производилась оценки показателей маркеров сепсиса - пресепсина, прокальцитонина и С-реактивного белка (СРБ) в крови больных в динамике эмпирической терапии антимикробными препаратами (АМП). Наибольшее число больных с выявленной бактериемией находилось в отделении ОАРИТ - 39 пациентов, у 25 из них был диагностирован сепсис по шкале СЕПСИС III, вызванный известными патогенами Staphylococcus aureus (46,6%) и Escherichia coli (36,6%). Для эмпирического лечения применялись различные антибиотики: ампенициллин, амикацин, меропенем, цефотаксим, метрид, ципрофлоксацин, ципрокс, цефлокс, цефазолин, цефтриаксон, левофлоксацин. Уровни прокальцитонина составляют для больных с клиническими изолятами E. coli 20,8±3,1нг/мл, а для изолятов St. aureus 15,7±1,8 нг/мл. После терапии АМП наблюдается значительное снижение показателей до 1,43±0,6 и 2,3±0,9 нг/мл., что позволяет признать эффективность эмпирической антибиотикотерапии при инфекциях кровотока. Высокая чувствительность клинических изолятов Escherichia coli отмечена к препаратам группы карбапенемов - имипенему и меропенему (90,9%), низкая к эртапенему (72,7%). 100% чувствительность все изоляты показали по отношению к АМП из группы глицилциклинов - тигециклину, который структурно сходен с тетрациклинами. Высокой резистеностью клинические изоляты Staphylococcus aureus обладают к пенициллину (92,9%), липопептиду природного происхождения даптомицину (85,8%) и препарату из группы линкозамидов - клиндамицину (64,3%). The results of a prospective examination of 80 patients with bacteremia from October 2019 to February 2021 from various departments of the hospital are presented. The largest number of patients with detected bacteremia were in the OARIT department - 39 patients, 25 of them were diagnosed with sepsis according to the SEPSIS III scale, caused by known pathogens Staphylococcus aureus (46.6%) and Escherichia coli (36.6%). For empirical treatment, various antibiotics were used: ampenicillin, amikacin, meropenem, cefotaxime, metrid, ciprofloxacin, ciprox, ceflox, cefazolin, ceftriaxone, levofloxacin. Procalcitonin levels for patients with clinical E. coli isolates are 20.8 ± 3.1 ng / ml, and for St. aureus 15.7 ± 1.8 ng / ml. After AMP therapy, there is a significant decrease in indicators to 1.43 ± 0.6 and 2.3 ± 0.9 ng / ml, which makes it possible to recognize the effectiveness of empiric antibiotic therapy for bloodstream infections. High sensitivity of clinical isolates of Escherichia coli was noted to drugs of the carbapenem group - imipenem and meropenem (90.9%), low to ertapenem (72.7%). All isolates showed 100% sensitivity to AMPs from the glycylcycline group - tigecycline, which is structurally similar to tetracyclines. Clinical isolates of Staphylococcus aureus are highly resistant to penicillin (92.9%), natural lipopeptide daptomycin (85.8%), and a drug from the lincosamide group - clindamycin (64.3%).

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Case of flexor tenosynovitis caused by Mycobacterium arupense

BMJ Case Reports ◽

10.1136/bcr-2021-245130 ◽

2021 ◽

Vol 14 (10) ◽

pp. e245130

Author(s):

Kushali Patel ◽

John Flaherty

Keyword(s):

Drinking Water ◽

Case Report ◽

Water Systems ◽

The Other ◽

Empiric Antibiotic Therapy ◽

Joint Infections ◽

Empiric Antibiotic ◽

Environmental Pathogens ◽

Fish Tanks ◽

Flexor Tenosynovitis

Mycobacterium arupense is a member of the Mycobacterium terrae complex (MTC) that is implicated in bone and joint infections, among others. This group of environmental pathogens can be found in soil, reclaimed and drinking water systems, rodents, fish tanks and bioaerosols in duck houses. Interestingly, while M. arupense is genotypically closely related to the other agents in the MTC, antibiotic susceptibility of these mycobacteria can vary widely and empiric antibiotic therapy is controversial. Our case report contributes to the very limited literature on M. arupense tenosynovitis—as only six cases have been reported since 2008—and sheds light on different courses of treatment. While previous cases have been successfully treated, a streamlined course of therapy for M. arupense tenosynovitis is still needed.

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Skin signs in acute pancreatitis: a case report

Italian Journal of Medicine ◽

10.4081/itjm.2010.265 ◽

2013 ◽

pp. 265-268

Author(s):

Marco Bassi ◽

Gelorma Belmonte ◽

Paola Billi ◽

Angelo Pasquale ◽

Massimo Reta ◽

...

Keyword(s):

Acute Pancreatitis ◽

Case Report ◽

Clinical Laboratory ◽

Epigastric Pain ◽

Multiorgan Failure ◽

Fluid Collection ◽

Clinical Signs ◽

Pancreatic Fluid Collection ◽

Retroperitoneal Hemorrhage ◽

Skin Signs

Introduction: Subcutaneous manifestations of severe acute pancreatitis (Cullen’s sign, Gray- Turner’s sign, Fox’s sign, and Bryant’s sign) are often discussed in journals and textbooks, but seldom observed. Although historically associated with acute pancreatitis, these clinical signs have been described in various other conditions associated with retroperitoneal hemorrhage. Case report: We describe the case of a 61-year-old male with no history of alcohol intake, who was admitted for epigastric pain, vomiting, and increasing serum amylase and lipase levels. Five days after admission, ecchymotic skin discoloration was noted over both flanks (Gray-Turner’s sign) and the upper third of the thighs (Fox’s sign). Ten days later, he developed multiorgan failure and was transferred to the ICU for 5 days. Computed tomography revealed a large pancreatic fluid collection, which was subjected to EUS-guided drainage. Cholecystectomy was later performed for persistent obstructive jaundice. After more than 4 months of hospitalization, he died as a result of severe gastrointestinal bleeding. Discussion and conclusions: Skin manifestations of retroperitoneal hemorrhage in a patient with acute pancreatitis indicate a stormy disease course and poor prognosis. The severity of acute pancreatitis is currently estimated with validated scoring systems based on clinical, laboratory, and imaging findings. However, skin signs like the ones discussed above can represent a simple and inexpensive parameter for evaluating the severity and prognosis of this disease.

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Man with epigastric pain and persistently elevated serum lipase

BMJ Case Reports ◽

10.1136/bcr-2019-229208 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229208

Author(s):

Caroline Annette Erika Bachmeier ◽

Adam Morton

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Epigastric Pain ◽

Elevated Serum ◽

Pancreatic Disease ◽

Radiological Assessment ◽

Serum Lipase ◽

Persistent Elevation ◽

Assay Interference ◽

Laboratory Assay

Serum lipase and amylase are commonly requested in individuals presenting with abdominal pain for investigation of acute pancreatitis. Pancreatic hyperenzymaemia is not specific for acute pancreatitis, occurring in many other pancreatic and non-pancreatic conditions. Where persistent elevation of serum lipase and amylase occurs in the absence of a diagnosed cause or evidence of laboratory assay interference, ongoing radiological assessment for pancreatic disease is required for 24 months before a diagnosis of benign pancreatic hyperenzymaemia can be made. We report a case of a 71-year-old man with epigastric pain and elevated serum lipase levels. He was extensively investigated, but no pancreatic disease was detected. He is asymptomatic, but serum lipase levels remain elevated 18 months after his initial presentation.

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ID: 33: ACUTE PANCREATITIS WITH NORMAL LIPASE AND AMYLASE ENZYMES

Journal of Investigative Medicine ◽

10.1136/jim-2016-000120.59 ◽

2016 ◽

Vol 64 (4) ◽

pp. 941.1-941

Author(s):

H Alkhawam ◽

C Catalano ◽

F Zaiem ◽

N Vyas ◽

M Fabisevich ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Epigastric Pain ◽

Pancreatic Head ◽

Uncinate Process ◽

Oral Contrast ◽

Significant Past Medical History ◽

Laboratory Findings ◽

Lipid Panel ◽

Basic Metabolic Panel

Case ReportA 44 year-old Male with no significant past medical history presented to the Emergency Department complaining of nausea, vomiting, diarrhea, upper abdominal pain and fever. For the past one week prior to presentation, patient developed pressure-like epigastric pain, radiating to the back, worsened with lying down, and associated with non-bloody, non-bilious vomiting, followed by anorexia, nausea and fever to 102F. Patient had not eaten several days prior to arrival to the hospital; hence he was brought in by his family for evaluation. Notably, two months prior to presentation, patient was evaluated in an outside hospital for abdominal pain similar in quality, but not in intensity, and reportedly had normal blood tests and imaging.Physical examination: vital signs significant for hypertension of 150/90, tachycardia to 108 and fever of 101.5; abdomen notable for tenderness to palpation over epigastrium, with mild guarding, but no rebound or Murphy's sign; the rest of the exam, including cardiovascular, pulmonary, integumentary and neurological exam, unremarkable. Initial laboratory findings are: WBC of 10.1, with 81% neutrophils, amylase of 47 (N 28–100 U/L), lipase level of 14 (N 11–82 U/L), and unremarkable basic metabolic panel. Liver function tests notable for normal AST and ALT, elevated GGT to 277 (N <50 U/L), LDH: 681 (N 90–225 U/L), Total bilirubin: 0.9(N 0–1.5 mg/dl). Lipid panel: Total Cholesterol 201 (N<200 mg/dL), Triglycerides 80 (N<150 mg/dL), LDL 68 (<100 mg/dL). Chest X-ray showed a small left-sided pleural effusion.Patient was admitted to medicine service for treatment of gastroenteritis, and was started on intravenous fluids and symptomatic management. On day three of hospitalization, patient developed worsening abdominal pain, associated with inability to tolerate per oral intake secondary to vomiting of food contents, and due to worsening abdominal pain, underwent further workup. CBC revealed leukocytosis with a left shift, WBC count of 15.3, with 81.5% neutrophils. Basic metabolic panel notable for sodium of 124, potassium of 3.2, calcium of 7.4, magnesium of 1.7, phosphate of 1.9. Repeat lipase was 67(N 11–82 U/L). An abdominal CT scan (figure 1) with IV and oral contrast was performed, and showed extensive pancreatic edema, especially involving the pancreatic head and uncinate process, and peripancreatic stranding; these changes deemed consistent with acute pancreatitis; no calcifications or pseudocysts were observed on the CT. Abdominal ultrasound showed multiple gallbladder stones, however, common bile duct was of normal diameter (2.5 mm), and no intrabiliary duct dilatation was noted.Based on clinical presentation and radiological findings, the diagnosis of acute pancreatitis was made. The patient started on aggressive intravenous fluid hydration, pain management and bowel rest, with good improvement in symptoms. On day 5, patient was able to tolerate a regular diet, and noted an almost complete resolution of pain, and therefore was discharged home.Abstract ID: 33 Figure 1

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Fishing-Injury-Related Flexor Tenosynovitis of the Hand: A Case Report and Review

Case Reports in Orthopedics ◽

10.1155/2013/587176 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Danny A. Young-Afat ◽

Deniz Dayicioglu ◽

John C. Oeltjen ◽

Audene P. Garrison

Keyword(s):

Infectious Disease ◽

Case Report ◽

Empiric Antibiotic Therapy ◽

Illustrative Case ◽

Soft Tissue Infections ◽

Severe Damage ◽

Appropriate Treatment ◽

Empiric Antibiotic ◽

Infectious Disease Specialists ◽

Flexor Tenosynovitis

Hand infections occurring after fishing and other marine-related activities may involve uncommon bacteria that are not susceptible to the conventional or empiric antibiotic therapy used to treat soft tissue infections. Therefore appropriate treatment is often delayed and could lead to severe hand damage. An illustrative case of fishing-related injury leading to complicated tenosynovitis and horseshoe abscess caused byMycobacterium marinumand its treatment course is outlined. Laceration of the skin during boating is fairly common. Because of the rarity of some of the bacteria, referrals to the appropriate specialist including hand surgeons and infectious disease specialists should occur in early stages.M. marinuminfections should always be considered in injuries related to seawater and fishing as this may lead to early appropriate treatment and prevent severe damage.

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