Infected Walled-Off Necrosis Following COVID-19-Associated Acute Pancreatitis

TL;DR

A man with severe COVID-19 developed acute pancreatitis and later infected walled-off necrosis, highlighting the need to monitor such complications in COVID-19 patients.

Contribution

This case report highlights infected walled-off necrosis as a rare complication of COVID-19-associated acute pancreatitis.

Findings

A 54-year-old man with severe COVID-19 developed acute pancreatitis and later infected walled-off necrosis.

Endoscopic transgastric drainage and necrosectomy improved the condition.

SARS-CoV-2 is increasingly recognized as a cause of acute pancreatitis with higher severity and mortality.

Abstract

A 54-year-old man was admitted for fever and dyspnea. He presented with severe COVID-19 pneumonia and elevated amylase and lipase levels. He received treatment for COVID-19 and possible acute pancreatitis (AP). Although pneumonia and amylase levels improved, a high-grade fever persisted. On day 39, abdominal CT revealed heterogenous liquid and non-liquid components with a well-defined wall around the pancreas, and he was diagnosed with infected walled-off necrosis (WON) after AP. It was concluded to be associated with COVID-19 because there were no identifiable causes, such as alcohol consumption, gallstones, or other viral infections. The necrotic collection and fever improved after endoscopic transgastric drainage and necrosectomy. SARS-CoV-2 is becoming recognized as a new etiological infectious factor for AP, and COVID-19-associated AP shows higher severity and mortality. Clinicians should evaluate COVID-19 patients for concomitant AP, and if it is present, they should carefully monitor the development of local complications, including WON.

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