Acute pancreatitis as a clinical presentation of COVID-19 in a patient with HIV infection: a case report

Abstract Background:Acute pancreatitis may be caused by many factors such as: viral infections, drugs, alcohol, autoimmune response. SARS-CoV-2 virus requires an angiotensin-converting enzyme 2 (ACE2) transmembrane protein in order to enter the cell. As ACE2 receptors are over 100 times more common in gastrointestinal (GI) tract than in respiratory tract and many SARS-CoV-2 infected patients present GI symptoms. Case presentation:A 26-year-old, HIV-positive man on effective combined antiretroviral therapy with normal CD4+ lymphocyte count level was consulted at the Emergency Department (ER) with mild COVID-19 symptoms, and referred for home isolation. Two weeks later and three weeks from first symptoms, he returned to ER with a three-day history of nausea and pain in the upper abdomen. He had no symptoms of respiratory tract infection, normal peripheral blood oxygenation and chest X-ray. He was admitted to the hospital and diagnosed with acute pancreatitis basing on the Revised Atlanta Classification. After discharge the patient continued to have food intolerance and abdominal discomfort for several weeks, but COVID-19 did not affect his HIV course. Three months post COVID-19 his anti-SARS-CoV-2 IgM and IgG antibodies were negative, and low level of 2 AU/mL of anti-S-RBD IgG antibodies was detected.Conclusions:SASR-CoV-2 infection is the most likely cause of pancreatitis in the presented patient. Several other case reports were published however none in HIV-positive patient. Therefore in COVID-19 patients serum amylase and lipase levels should be included into routine laboratory tests’ panel. Abdominal ultrasound and CECT should be considered as diagnostic tool in patients with abnormal laboratory findings or clinical manifestation suggesting GI tract involvement.