P3614 - The Dual Assault of COVID-19: Hepatitis and Pancreatitis

Award: Presidential Poster Award

Omar Asad, MD¹, Hakeem Asad, MD², Natalie Balassiano, MD³, Amal Benchakroun, MD⁴, Panida Charnvitayapong, MD¹, Tiana De Carolis, MD⁴, Klaus Danjolli, MD^4
1University of Miami Miller School of Medicine at JFK Medical Center, Lantana, FL; ²Mayo Clinic College of Medicine and Science, Doral, FL; ³NYU Queens Hospital, Queens, NY; ⁴University of Miami Miller School of Medicine at JFK Medical Center, Atlantis, FL

Introduction: Coronavirus (COVID-19) is an RNA virus primarily known to cause respiratory tract infections. However, gastrointestinal involvement is not uncommon. There have been reported cases of COVID-19 associated acute pancreatitis & acute hepatitis independently. Here we present a rare simultaneous case of viral hepatitis (VH) & viral pancreatitis (VP) due to COVID-19.

Case Description/Methods: 33 year old female presented with diffuse abdominal pain radiating to the back, nausea, & vomiting. Physical exam was significant for scleral icterus, tender abdomen, & hypotension. Lab results showed leukocytosis & significantly elevated liver & pancreatic enzymes. A CT abdomen with contrast revealed acute pancreatitis, hepatomegaly, but no gallstones or biliary dilatation. She denied alcohol, medication, or herbal supplement use. She reported testing positive for COVID-19 five days prior to presentation. She was managed conservatively with IV fluids, bowel rest, & analgesics. Viral hepatitis panel & autoimmune markers were negative.

Discussion: VH & VP are two individual disease processes associated with various viruses such as Cytomegalovirus, Epstein–Barr virus, hepatitis viruses (A, B, C, D, E), HIV, & varicella zoster. However, only the hepatitis viruses have been reported to cause both pathologies simultaneously, particularly hepatitis B & C. Although the exact pathogenesis is not fully understood, the proposed hypotheses involves direct viral infection, immune-mediated response, & systemic inflammatory response.



Here we demonstrate a rare case of COVID-19, a virus shown to cause both pathologies independently, presenting with both diseases. Firstly, hepatocytes & pancreatic cells have been found to express ACE2 receptors, allowing viral entry & resulting in direct cellular injury & inflammation. Secondly, COVID-19 has been linked to many autoimmune conditions, suggesting molecular mimicry as the potential pathogenesis. Antibodies produced in response to the virus may cross-react with liver & pancreatic tissues leading to inflammation. This suggests the presence of either a shared antigen in both pancreatic & hepatic cells, or two distinct antigens—one expressed in pancreatic cells & the other in hepatic cells—that the immune system simultaneously mimics. Lastly, the excessive release of pro-inflammatory cytokines, such as IL-6 & TNF-α, can cause widespread inflammation, resulting in pancreatic & liver injury. Further research is warranted to understand the exact pathogenesis & connection between VH & VP.


Disclosures:


Omar Asad, MD¹, Hakeem Asad, MD², Natalie Balassiano, MD³, Amal Benchakroun, MD⁴, Panida Charnvitayapong, MD¹, Tiana De Carolis, MD⁴, Klaus Danjolli, MD⁴. P3614 - The Dual Assault of COVID-19: Hepatitis and Pancreatitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.