Case 1
A 62-years old male patient, complaining of severe abdominal pain
radiating to the back and vomiting in the last 4 days, was admitted to
the Emergency Unit. At entry, body temperature 36,6°C, blood pressure
135/85 mm Hg, heart rate 88 bpm, and oxygen saturation 94% at room air.
Laboratory tests showed normal blood count and no signs of cholestasis,
whilst an increase of C-reacting protein (12 mg/L; n. v. < 8
mg/L) and ESR 27 (mm/h; n. v. 1-19 mm/h), with a 4-fold increased levels
of both amylase (534 U/L – n. v. 25-125 U/L) and lipase (326 U/L – n.
v. 8-78 U/L). Abdominal ultra-sonography (US) showed pancreatic
enlargement with multiple peri-pancreatic fluid collection in the
body-tail area, normal bile ducts, and absence of biliary stones.
The real time polymerase chain reaction (RT-PCR) nasopharyngeal swab
resulted positive for CoViD-19 and chest X-ray was negative without
respiratory symptoms. The patient was admitted in CoViD Unit with
diagnosis of AP in asymptomatic CoViD patient, and standard treatment
for AP (fluid replacement, optimization of electrolyte balance) was
started, requiring any treatment for his CoViD-19 infection. The medical
history did not reveal potential aetiologias of AP.
Following 6 days, the patient developed acute symptoms with worsening
abdominal pain, fever (39,8°C), chills, marked increase of ESR (85 mm/h)
and C-reactive protein (215 mg/l), and leucocytosis (WBC 26.000 x
103/UL; n. v. 4,8-10,8 x 103/UL).
The abdominal CT scan showed a large pancreatic pseudocyst (PP) (17x8x12
cm) developing in the anterior pancreatic body-tail area. Due to the
development of recurrent, bulging vomiting, we decided, on the hospital
day 9, to perform an endoscopic ultrasound-guided trans-gastric drainage
of the pseudocyst and a Hot Axios 15 mm stent (Boston Scientific,
Marlborough, MA, USA) was successfully placed (Figure 1A). Before the
endoscopic procedure, the pseudocyst fluid sample was collected and
the presence of
Covid-19 confirmed by RT-PCR analysis with both AllplexTM 2019-nCoV
(Seegene, Arrow Diagnostics, South Korea) and Quanty Covid-19 (Clonit,
Italy) assays 2.
Two weeks after stent placement, the pancreatic pathology recovered
(Figure 1B). Following 2 negative molecular swabs, the patient was
discharged from the hospital at day 26, with a planned US for stent
removal.