Table 2 Published cases of acute pancreatitis associated with SARS-CoV-2 infection
Author | Country | Age | Sex | Pulmonary symptoms | Extra-pulmonary symptoms | Physical examination findings | Chest CT | Abdominal CT | Serum lipase and serum amylase | SARS-CoV-2 RT-PCR | Other laboratory test performed to exclude other etiologies | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Myeres et al. [13] | USA | 67 | Male | Acute hypoxic respiratory failure | Acute onset epigastric abdominal discomfort and fever | Epigastric tenderness | Ground-glass opacity in the right lung apex | Acute interstitial edematous pancreatitis with moderate peripancreatic stranding and edema | L: 5295 U/L A: not reported | Not done; only SARS-CoV-2 rapid test was positive 3 days after onset of abdominal pain and 2 days after hospitalization | Liver chemistry tests, serum triglycerides, serum immunoglobulin G4 | Alive |
Samies et al. [14] | USA | 15 | Male | Nasal congestion | Anosmia, ageusia, vomiting, and abdominal pain | Epigastric tenderness | Scattered ground-glass opacities in bilateral lung fields | Mild stranding around the head of the pancreas | L: 233 U/L (4–39 U/L) A: not reported | Positive 2 days after onset of abdominal pain and 1 day after hospitalization | Liver chemistry tests, serum triglycerides. | Alive |
Samies et al. [14] | USA | 11 | Male | None reported | Headache, chills, tactile fever, abdominal pain, hematochezia, and epistaxis | Epigastric tenderness | Interstitial opacities with peribronchial thickening | Fatty infiltration of the liver, enlarged appendix, and normal pancreas | L: 582 U/L (4–39 U/L) A: 156 U/L | Positive on the same day of onset of abdominal pain and 2 days prior to hospitalization | Liver chemistry tests, serum triglycerides (elevated to 251 mg/dl), cholesterol (normal) | Alive |
Samies et al. [14] | USA | 16 | Female | Cough | Subjective fever, nausea, and abdominal pain | Epigastric tenderness | Not evaluated | Hepatomegaly, single gallstone, and prominence of the pancreas | L: 1909 U/L (4–39 U/L) A: not reported | Positive 1 week prior to onset of abdominal pain | Liver chemistry tests, serum triglycerides, cholesterol | Alive |
Fernandes et al. [15] | Brazil | 36 | Female | Dyspnea | Fever, headache, and abdominal pain | Not reported | Bilateral pulmonary opacities | Acute interstitial pancreatitis with acute peripancreatic fluid collection | L: 640 U/L A: 710 U/L | Positive | None reported | Alive |
Lakshmanan et al. [16] | USA | 68 | Male | None reported | Loss of appetite, anorexia, nausea, and vomiting | Dehydration, lethargy, and soft, nontender abdomen | Not evaluated | Peripancreatic fat stranding, most remarkable around the tail, with mild duodenal wall thickening and adjacent fat stranding, likely from pancreatitis. The gallbladder appeared normal, without wall thickening or surrounding inflammatory changes, and the common bile duct was not dilated | L: 2035 U/L A: 1030 U/L | Positive 2 days prior to hospitalization and 7 days prior to diagnosis of pancreatitis | Liver chemistry tests, total bilirubin, serum triglycerides, serum calcium | Alive |
Kurihara et al. [17] | Japan | 55 | Male | Severe respiratory distress necessitated intubation and ECMO | Could not be evaluated due to sedation | Could not be evaluated due to sedation | Not evaluated | Pancreas with diffuse parenchymal enlargement and stranding of the surrounding retroperitoneal fat | L: 263 U/L (16–55 U/L) A: 252 U/L (44–132 U/L) | Positive on day 8 after respiratory symptom onset | Serum triglycerides (mild elevation), serum calcium | Alive |
Alves et al. [18] | Brazil | 56 | Female | Dry cough and dyspnea | General malaise and epigastric pain | Not reported | Multiple ground-glass opacities, interlobular septal thickening, and consolidation areas | Heterogeneously enhancing and edematous pancreas | L: 2993 U/L A: 544 U/L | Positive | Serum triglycerides (209 mg/dl), serum calcium (1.24 mg/dl) | Alive |
Wang et al. [19] | China | 42 | Male | Chest discomfort and shortness of breath | Nausea and persistent upper abdominal pain with radiation to the back for 3 days | Not reported | Multiple ground-glass opacities in both lungs | The prominence of the pancreas and peripancreatic fluid accumulation, without biliary dilatation or microlithiasis | L: 382 U/L (0–180 U/L) A: 132 U/L (0–180) | Positive on day 5 of abdominal pain | Serum triglycerides: 3.2 mmol/L ( < 1.7 mmol/L), Serum calcium | Dead |
Wang et al. [19] | China | 35 | Male | None reported | Five days of persistent upper abdominal pain with radiation to the back, nausea, and vomiting | Not reported | Patchy shadows in the lower right lung and bilateral pleural effusion | Pancreatic swelling, peripancreatic fluid accumulation, and prerenal fascial thickening without biliary dilatation or microlithiasis | L: 1042 U/L (0–180 U/L) A: normal | Positive on day 6 of abdominal pain | Serum triglycerides: 3.97 mmol/l ( < 1.7 mmol/l), Serum calcium | Alive |
Patnaik et al. [20] | India | 29 | Male | Dyspnea | Acute diffused abdominal pain of 5 days duration that radiated to the back and progressively worsened and low-grade fever | Abdominal tenderness maximal in the umbilical region | Not evaluated | Swollen pancreas | L: 1650 U/L A: 2861 U/L | Positive | Serum triglycerides, serum calcium | Alive |
Kumaran et al. [21] | UK | 67 | Female | None reported | Epigastric pain, diarrhea, and vomiting | Not reported | Not evaluated | Necrotizing pancreatitis | L: not evaluated A: 1483 U/L | Positive | Liver chemistry tests, serum triglycerides, serum calcium, immunoglobulin G4 | Alive |
Gonzalo-Voltas et al. [22] | Spain | 76 | Female | None reported | Epigastric pain, fever, vomiting, and diarrhea | Not reported | Not evaluated | Interstitial edematous pancreatitis | L: not evaluated A: 3568 IU/L | Positive | None reported | Alive |
Cheung et al. [23] | USA | 38 | Male | None reported | Fever and epigastric pain | Not reported | Not evaluated | Not evaluated | L: 10,255 ukat/L | Positive 1 week prior to presenting in the emergency department | Liver chemistry tests, serum triglycerides, serum calcium, serum bilirubin | Alive |
Kataria et al. [24] | USA | 49 | Female | Dry cough, shortness of breath, and hypoxic respiratory failure | Fever, nausea, vomiting, and severe abdominal pain radiating to the back | Not reported | Multifocal infiltrates involving the posterior basal segment of the left lower lobe and an apical–posterior segment of the left upper lobe | Diffuse enlargement of pancreas with ill-defined borders and surrounding peripancreatic fluid | L: 1451 IU/L (0–160) A: 501 IU/L (30–110) | Positive on the second day of hospitalization | Liver chemistry tests, serum triglycerides, serum cholesterol, serum calcium, total bilirubin | Alive |
Brikman et al. [25] | Israel | 61 | Male | Cough, dyspnea, and hypoxemia | Fever, weight loss, and diffuse abdominal tenderness | Soft abdomen with no signs of peritoneal irritation | Not evaluated | Focal parenchymal enhancement of the pancreas head with inflammatory changes in peripancreatic fat | L: 203 U/L (21–67 U/L) A: 142 U/L (28–100 U/L) | Positive | Serum triglycerides: 3.18 mmol/L (1.8 mmol/L), direct bilirubin | Alive |
Mazrouei et al. [26] | UAE | 24 | Male | Mild upper respiratory tract symptoms | Nonradiating epigastric pain, nausea, and vomiting | Epigastric discomfort on palpation | Not evaluated | Edema of the distal pancreas with surrounding fluid | L: 578 IU/L A: 391 U/L | Positive 1 day prior to presenting to the emergency department | None reported | Alive |
Bokhari et al. [27] | Pakistan | 32 | Male | Sore throat and productive cough | High fever, chills, severe epigastric pain radiating to back, and nonbilious vomiting | Not reported | Not evaluated | Bulky and swollen pancreas with significant peripancreatic inflammatory changes and fluid collection along the gastrosplenic ligament | L: 721 IU/L A: 672 IU/L | Positive 8 days after onset of symptoms. | Liver chemistry tests, serum triglycerides, serum calcium | Alive |
Alloway et al. [28] | USA | 7 | Female | None reported | Fever and abdominal pain | Distension and tenderness to palpation in the left upper and left lower quadrant, and the epigastric regions | Not evaluated in the second attack (the first attack showed small bilateral pleural effusion) | Not evaluated in the second attack (the first attack showed necrotizing pancreatitis) | L: 676 U/L in the first attack 1672 U/L in the second attack (80–360 U/L) A: not reported | Not done in the first attack Positive in the second attack | Serum LDH | Alive |
Rabice et al. [29] | USA | 36 | Female (33 weeks pregnant) | Dry cough and dyspnea | Nausea, vomiting, and epigastric pain | Epigastric tenderness | Not evaluated | Not evaluated | L: 875 U/L A: 88 U/L | Positive | Liver chemistry tests. Serum triglycerides (210 mg/dl) | Alive |
Pinte et al. [30] | Romania | 47 | Male | Dry cough | Severe epigastric pain with radiation to the back, nausea, constipation, and lack of flatus | Epigastric tenderness | Scattered bilateral subpleural ground- glass opacities | Blurring of the pancreatic contours due to the edema of the surrounding adipose tissue | L: 22× upper limit of normal A: 6× upper limit of normal | Positive | Serum triglycerides, serum calcium, gamma-glutamyltranspeptidase | Alive |
Meireles et al. [31] | Portugal | 36 | Female | Dry cough, breathlessness, and fever | Nausea, vomiting, and epigastric pain | No physical findings | Bilateral ground-glass opacities with 75–100% lung involvement | No pancreatic abnormalities | L: 631 U/L A: 718 U/L | Positive 4 days after onset of cough | Serum triglycerides, serum cholesterol, serum calcium, ANA screening. Anti-HIV 1 and 2, HBs antigen, anti-HCV antibody, anti-Coxsackie antibody (IgM/IgG), anti-herpes virus 1 antibody (IgM/IgG), anti-herpes virus 2 antibody (IgM/IgG), anti-CMV antibody (IgM/IgG) | Alive |
Miao et al. [32] | France | 26 | Female | None reported | Fever, epigastric pain, and severe vomiting | Not reported | Bilateral basal condensations and pleural effusions | Enlarged pancreas gland without any structural abnormality | L: 211 U/L A: not reported | Positive | Liver chemistry tests, serum triglycerides, serum calcium, serological tests for human immunodeficiency virus, hepatitis B and C, Coxsackie viruses, Chlamydia, Mycoplasma, antinuclear and anti-DNA antibodies | Alive |
Aloysius et al. [33] | USA | 36 | Female | Dry cough and progressive dyspnea | Fever, stabbing epigastric pain, vomiting, and diarrhea | Severe epigastric tenderness | Multifocal bilateral ground-glass opacities | Normal | L: 627 U/L A: 325 U/L | Positive | Liver chemistry test, serum triglycerides, serum procalcitonin, total and direct bilirubin | Unknown |
Hadi et al. [34] | Denmark | 47 | Female | Acute respiratory distress | None reported | Not reported | Not evaluated | Not evaluated | L: not evaluated A: more than 1500 U/L | Positive | Serum triglycerides, serum calcium | Still in ICU |
Hadi et al. [34] | Denmark | 68 | Female | Dyspnea and hypoxia that necessitated intubation and mechanical ventilation | Abdominal pain | Epigastric tenderness | Not evaluated | Not evaluated | L: not evaluated A: 934 U/L | Positive | Serum triglycerides, serum calcium | Still in ICU |
Anand et al. [35] | UK | 59 | Female | Cough and sore throat | Fever, myalgia, abdominal pain, and constipation | Not reported | Not evaluated | A previously atrophic pancreas that had increased markedly in size and had features of diffuse edematous changes, suspicious for acute pancreatitis | L: not evaluated A: not evaluated | Positive | None reported | Alive |
Hassani et al. [36] | Iran | 78 | Female | None reported | Severe positional epigastric pain precipitated by lying supine, nausea, vomiting, and chills with no fever | Epigastric tenderness | Patchy peripheral ground glass infiltrations in both lungs | Not evaluated | L: 230 IU/L A: 185 IU/L | Positive | Liver chemistry tests, lipids profile, serum electrolytes | Alive |
Kandasamy et al. [37] | India | 45 | Female | None reported | Severe sharp epigastric pain radiating to the back | Severe epigastric tenderness | Multifocal areas of ground-glass opacities, consistent with CO-RADS score of 5 | Diffusely enlarged pancreas with acute peripancreatic and pararenal collections | L: 293 IU/L A: 364 IU/L | Positive | Liver chemistry, total bilirubin, gamma-glutamyltransferase, alkaline phosphatase | Alive |