Treatment: With this above scenario of acute pancreatitis she
had been treated with adequate bowel rest, intravenous fluid therapy,
injectable broad spectrum antibiotics, omeprazole and pethedine. Our
expert opinion suggested to stop Favipiravir due to inadequate data of a
new molecule as a temporal cause of her acute pancreatitis. Gradually we
noticed her uneventful improvement with this medications including
stable oxygen saturation 97% on room air. Finally she was discharged on
oral medications with symptoms free acute pancreatitis after test
negative RT-PCR for COVID-19. We advised her to continue injection
Enoxaparin as a therapeutic dose for the next 14 days at home followed
by oral Rivaroxaban 10mg daily. Her ongoing antihyprertensive and
antidiabetic medications Losartan Potassium and insulin were preserved
respectively whereas Metformin was omitted shortly after her positive
RT-PCR test of COVID-19.
Outcome and Follow-up: However her discharge period was also
uneventful and we had followed her up 7 and 14days later with Complete
blood count, C - reactive protein, random blood sugar, liver function
test, S. creatinine, S. Lipase, S. electrolytes, D- Dimer, chest
radiography, ultrasonography of whole abdomen (Table-3, Table-4,
figure-3, Figure-4). She had not developed any secondary complications
of acute pancreatitis during her discharge period.
Discussion: According to the Atlanta classification and
definition by international consensus, acute pancreatitis can be
diagnosed following presence of at least two out of three points: 1)
abdominal pain suggestive of acute pancreatitis, 2) lipase or amylase
more than three times higher the normal upper limit, and c) sonography
or radiography findings pertinent with acute
pancreatitis.7 Therefore our case has been diagnosed
as an acute pancreatitis following all the criteria of Atlanta
classification and definition. Though the exact mechanism of acute
pancreatitis by SARS-CoV-2 infection is unknown but the cytopathic
effect, systemic inflammatory responses or harmful immune response
mediated by local SARS-CoV-2 replication or infection are thought to be
responsible for the pathogenesis of acute pancreatitis here. However
SARS-CoV-2 mediated acute pancreatitic injury had been
evident8 whereas COVID-19 induced seldom established
acute pancreatitis case reported till date
globally.9,10
Conclusion: Wide spectrum atypical presentations including
acute pancreatitis are evident by SARS-CoV-2 infection. Therefore, any
manifestation of its complication should be kept as high index clinical
suspicious during management of COVID-19.