Coronavirus Disease-19-associated Acute Pancreatitis: Report of Three Cases and Review of Case Reports

BACKGROUND: Reports on coronavirus disease 2019 (COVID-19) associated with acute pancreatitis continue to emerge. In this series, we present three cases of acute pancreatitis associated with COVID-19 with no obvious etiology. CASE REPORTS: The first case was a 47-year-old man who presented with severe abdominal periumbilical pain, preceded by fever and dry cough. Based on a positive COVID-19 polymerase chain reaction (PCR) test and elevated serum amylase and lipase >3 times the upper normal limit, the diagnosis of COVID-19 and acute pancreatitis were established. The next case was a 57-year-old man with confirmed COVID-19 who developed severe epigastric pain radiating to the back and was associated with nausea and vomiting. His serum amylase and lipase were elevated >3 times the upper normal limit confirming the diagnosis of acute pancreatitis. The third case was a 31-year-old man who presented to the emergency department with a few hours of severe epigastric pain radiating to the back associated with nausea and vomiting. Two days before his presentation, he had a runny nose and fever. A combination of serum amylase and lipase elevation, >3 times the upper normal limits, and a positive COVID-19 PCR test were obtained concurrently, confirming the diagnosis of COVID-19 associated acute pancreatitis. All patients were admitted to the Mesaieed Hospital COVID-19 facility and received treatment for COVID-19 according to our local guidelines, while acute pancreatitis was treated conservatively. All three patients were discharged in good condition. CONCLUSION: This case series suggests a possible correlation between COVID-19 and acute pancreatitis.

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Abdominal pain and a raised amylase? It’s not always pancreatitis…

Acute Medicine Journal ◽

10.52964/amja.0310 ◽

2013 ◽

Vol 12 (3) ◽

pp. 163-165

Author(s):

IO Oluwatowoju ◽

◽

EO Abu ◽

G Lawson ◽

◽

...

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Epigastric Pain ◽

Elevated Serum ◽

High Serum ◽

Amylase Level ◽

Serum Amylase Level ◽

Heavy Alcohol ◽

Heavy Alcohol Consumption ◽

History Of

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

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Presentation and Management of Liraglutide-Related Pancreatitis: Systematic Review of Case Reports

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.853 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A418-A418

Author(s):

Som P Singh ◽

Fahad Qureshi

Keyword(s):

Systematic Review ◽

Acute Pancreatitis ◽

Systematic Reviews ◽

Serum Amylase ◽

Age Of Onset ◽

Case Reports ◽

Meta Analysis ◽

Elevated Serum ◽

Duration Of Treatment ◽

Significant Difference

Abstract Background: Liraglutide is a glucagon-like peptide-1 (GLP-1 agonist) aimed towards promoting glucose-dependent insulin secretions. This medication is an emerging treatment option for the management of obesity through promoting satiety. However, there are a growing number of cases noting adverse effects of liraglutide. Of note, liraglutide has been seen to elevate serum amylase and lipase levels among users, and therefore promoting acute pancreatitis. Moreover, the overall presentation of liraglutide-related acute pancreatitis can be variable. The aim of this study is to determine qualitative patterns of presentation and meta-analysis of lab changes among acute pancreatitis patients on liraglutide. Methodology: Systematic review of the literature was performed on MEDLINE, Google Scholar, and the Cochrane Database of Systematic Reviews for liraglutide-related acute pancreatitis case studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Meta-Analysis performed using Stata. Results: Twenty-one patient cases were identified then contingently evaluated for acute pancreatitis based on presentation, labs, and treatment outcomes. Within the pancreatitis cases, the average age of onset was 59 ± 16.5 (male = 58 ± 24.5; female = 56 ± 24.6). Upon qualitative review, 14.3% of patients were asymptomatic but showed elevated serum amylase and lipase levels following liraglutide administration (p < 0.05). Among the symptomatic group, there was variation in the duration of liraglutide administration and reported compliance. There was no significant difference among treatment regimes between symptomatic and asymptomatic groups. Conclusion: Longer duration of liraglutide treatment without dose adjustment was notable to show elevated rises in both serum amylase and lipase. However, the variation of patient symptoms cannot be determined through the duration of treatment. Patient demographics do not seem to play a role in acute pancreatitis episodes. Future studies ought to focus on larger patient samples to further develop an understanding of treatment duration, presentation, and management of acute pancreatitis management after liraglutide administration.

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Acute Pancreatitis with Rapid Clinical Improvement in a Child with Isovaleric Acidemia

Case Reports in Pediatrics ◽

10.1155/2013/721871 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Elpis Mantadakis ◽

Ioannis Chrysafis ◽

Emmanouela Tsouvala ◽

Athanassios Evangeliou ◽

Athanassios Chatzimichael

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Acute Abdominal Pain ◽

Elevated Serum ◽

Unknown Origin ◽

Organic Acidemia ◽

Abdominal Ultrasonography ◽

Isovaleric Acidemia ◽

Intravenous Hydration ◽

Branched Chain

Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin.

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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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Significantly Elevated Serum Lipase in Pregnancy with Nausea and Vomiting: Acute Pancreatitis or Hyperemesis Gravidarum?

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/359239 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Amanda Johnson ◽

Bethany Cluskey ◽

Nina Hooshvar ◽

Daphne Tice ◽

Courtney Devin ◽

...

Keyword(s):

Acute Pancreatitis ◽

Biochemical Marker ◽

Hyperemesis Gravidarum ◽

Elevated Serum ◽

Clinical Findings ◽

Nausea And Vomiting ◽

Imaging Studies ◽

Severe Nausea ◽

Serum Lipase ◽

Severe Manifestation

Hyperemesis gravidarum is a severe manifestation of nausea and vomiting of pregnancy and it is associated with weight loss and metabolic abnormalities. It is known that abnormal laboratory values, including mildly elevated serum lipase level, could be associated with hyperemesis gravidarum. However, in this case report details of two women with hyperemesis gravidarum but with significantly elevated serum lipase levels were discussed. These patients presented with severe nausea and vomiting but without abdominal pain. They were found to have severely elevated lipase levels over 1,000 units/liter. In the absence of other findings of pancreatitis, they were treated with conservative measures for hyperemesis gravidarum, with eventual resolution to normal lipase levels. Although significantly elevated lipase level in pregnant patients with nausea and vomiting is a concern for acute pancreatitis, these two cases of significantly elevated serum lipase without other clinical findings of pancreatitis led to this report that serum lipase could be quite elevated in hyperemesis gravidarum and that it might not be an accurate biochemical marker for acute pancreatitis. Imaging studies are thus necessary to establish the diagnosis of acute pancreatitis.

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Severe Epigastric Pain with Nausea and Vomiting

Surgery ◽

10.1007/978-3-030-05387-1_20 ◽

2019 ◽

pp. 227-237

Author(s):

Areg Grigorian ◽

Matthew Y. C. Lin ◽

Christian de Virgilio

Keyword(s):

Epigastric Pain ◽

Nausea And Vomiting ◽

Severe Epigastric Pain

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Acute painless pancreatitis as an unusual presentation of leptospirosis in a low-incidence country

BMJ Case Reports ◽

10.1136/bcr-2020-234988 ◽

2020 ◽

Vol 13 (8) ◽

pp. e234988

Author(s):

Ami Schattner ◽

Ina Dubin ◽

Yair Glick ◽

Elizabeth Nissim

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Liver Enzymes ◽

Elevated Serum ◽

Kidney Injury ◽

C Reactive Protein ◽

Diagnostic Challenge ◽

Reactive Protein ◽

Animal Contact ◽

Low Incidence

A healthy, urban-dwelling man presented with lassitude, jaundice without increased liver enzymes or obstructive features on imaging, brief acute kidney injury, leucocytosis with near-normal C reactive protein and markedly increased serum amylase and lipase. Leptospirosis was not considered for 10 days because of the low incidence of the disease in the country, absent animal contact and physicians’ low index of suspicion. Presentation without fever and without the commonly associated abdominal pain, myalgia, headache, thrombocytopaenia or elevated serum creatine kinase added to the diagnostic challenge. Once an infectious cause of acute pancreatitis was contemplated, leptospirosis was immediately sought and diagnosed by PCR of urine and microscopic agglutination test, and he fully recovered on ceftriaxone. Physicians in countries with a low incidence of leptospirosis should be more aware of the possibility of the disease even when several key features such as fever or pain are missing and the patient has a rare infectious acute pancreatitis.

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A Cause of Misleading Serum Amylase Concentrations in Acute Pancreatitis

Scottish Medical Journal ◽

10.1177/003693307702200212 ◽

1977 ◽

Vol 22 (2) ◽

pp. 151-153 ◽

Cited By ~ 4

Author(s):

L. A. Donaldson ◽

W. McIntosh

Keyword(s):

Acute Pancreatitis ◽

Serum Level ◽

Serum Amylase ◽

Elevated Serum ◽

Serial Dilutions

The operative discovery of acute pancreatitis associated with gross hyperlipidaemia but a normal or high elevated serum amylase concentration has been described. We report a case of acute pancreatitis in which serial dilutions of serum resulted in a 338 per cent rise in the serum amylase concentrations. The importance of appreciating this effect of hyperlipidaemia on the serum level measurements in patients with acute pancreatitis is re-emphasised.

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Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

Bangladesh Journal of Child Health ◽

10.3329/bjch.v40i3.33057 ◽

2017 ◽

Vol 40 (3) ◽

pp. 160-165

Author(s):

Nadira Musabbir ◽

ASM Bazlul Karim ◽

Md Wahiduzzaman Mazumder ◽

Kaniz Sultana ◽

Syeda Afria Anwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Serum Amylase ◽

Abdominal Mass ◽

Elevated Serum ◽

Clinical Feature ◽

Cross Sectional ◽

Female Ratio ◽

Epigastric Region ◽

Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

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