Even through pancreas had been reported to be one of the potential target organs of SARS-CoV-2, few clinical cases about SARS-CoV-2-induced pancreas injury had been reported and the underlying mechanism was still unclear[3, 4]. This study described incidence of acute pancreatitis in a patient with COVID-19 to grabs attention of physicians on SARS-CoV-2-associated pancreas injury in COVID-19 patients with complex comorbidities.
As demonstrated, alcohol misuse, gluttony and gallstone were main etiology of acute pancreatitis[5] while in this case, these inducements were all excluded based on medical history and clinical detections. It had been approved in HIV patients that LPV/r increased incidence of hypertriglyceridemia and hyperlipidemia which was associated with acute pancreatitis[6]. However, direct connection of acute pancreatitis with ritonavia-induced hypertriglyceridemia was only illustrated in few cases[7]. Meanwhile, COVID-19 patients with hypertriglyceridemia was not seen clinical acute pancreatitis and in this case, hypertriglyceridemia occurred after incidence of acute pancreatitis[8].
Previous studies revealed that patients with SARS-CoV infection were at high risk of developing injury pancreas causes acute diabetes and pancreatitis [9]. SARS-CoV-2, similar with SARS-Cov, one of the βcoronavirus virus, was reported to enter organs by binding with angiotensin-converting enzyme 2 (ACE2)[9, 10]. And ACE2 was presented in kidney, liver, adipose tissue and pancreas[10]. This may be one of the reasons explaining that SARS-induced pancreas injury contributed to acute diabetes and pancreatitis[9, 10]. The acute pancreatitis appeared after the RNA of SARS-CoV-2 turned negative in sputum, which means that acute pancreatitis may occur in COVID-19 patients with clearance of SARS-CoV-2 in lung.
In conclusion, our case provided an initial view of SARS-CoV-2 infection with acute pancreatitis and the acute pancreatitis may occur in COVID-19 patients with clearance of SARS-CoV-2 in lung. However, since lacking of pathological biopsy in this case, it is still unclear about the direction relationship between SARS-CoV-2 infection with acute pancreatitis, indicating that further researches should be done for our better understanding of coronavirus induced pancreatitis.