Pancreatitis after COVID-19 vaccines

A 24-year-old South-Asian female received er first dose of the Pfizer vaccine at 30 weeks of gestation. One week later she presented with severe epigastric pain radiating to the back and worsening on lying supine, associated with nausea and vomiting. She was diagnosed with acute pancreatitis with a serum lipase level of 4376 U/L and an ultrasound showing features of pancreatitis. The patient had a spontaneous vaginal delivery, and the baby was shifted to the neonatal intensive care unit in a stable condition. A computed tomography scan postpartum (day 2) demonstrated acute interstitial edematous pancreatitis. The patient was managed conservatively in the intensive care unit and discharged home in a stable condition.

A 28-year old previously healthy woman  experienced abdominal pain three days after the injection of the second dose of the Sinopharm COVID-19 vaccine. She presented at the emergency department but all the tests and imaging were normal and she was discharged with supportive treatments. About a week after the second dose of the vaccine, she suffered severe pain in her legs and then numbness in her left leg. During an outpatient visit to a neurology clinic, naproxen, gabapentin, vitamin B1, and magnesium due to neuropathy diagnosis were prescribed. 2.5 months later she presented with a chief complaint of severe abdominal pain; she was constipated for 4 days and had a tingling sensation in the face and fingers.  She was hospitalized with a diagnosis of acute pancreatitis

A 43‐year‐old European male living in New Zealand was diagnosed with acute necrotizing pancreatitis 10 h following the administration of his second Pfizer‐BioNTech COVID‐19 mRNA vaccine. He had a background of atopy with seasonal rhinitis, eczema, and asthma, all of which are “mild.” He had a previous episode of pancreatitis in 2011, precipitated by high alcohol intake during a holiday abroad, but was otherwise healthy. Four hours after the second vaccine dose, he had two 330 ml bottles of 5% alcohol beer with his dinner. Six hours after the dose, he became unwell with nausea, epigastric pain, and vomiting. This case of acute pancreatitis was temporally associated with the Pfizer‐BioNTech COVID‐19 mRNA vaccine suggesting a causal link.

96-year-old Caucasian female with a past surgical history of cholecystectomy presented with acute onset severe abdominal pain a few days after getting the first dose of Pfizer-BioNTech COVID-19 vaccine. She was diagnosed with acute pancreatitis with a lipase level of 4036 U/L. Extensive history and investigations were unable to find any etiology. The patient was conservatively managed and discharged home without any complications.

Trial data of Pfizer COVID-19 also shows one case of acute pancreatitis in the treatment group. As of June 2021, 176 cases of post-vaccine pancreatitis have been reported to WHO. There have been many more individual cases of unexplained acute pancreatitis shared by medical professionals on online forums. Acute pancreatitis is rare in patients with COVID‐19 but characteristic patterns of illness have been reported. One recent case report presented an incidental 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) finding of mild pancreatic inflammation/pancreatitis in an otherwise asymptomatic 35-year-old male patient undergoing routine imaging as part of the staging process following stem cell transplant, who had recently recovered from a severe form of COVID infection. This case highlighted the fact that COVID can trigger insidious inflammatory processes in a variety of organs often remaining clinically undetectable until resultant end-organ damage causes incipient clinical symptoms.


Post-vaccine pancreatitis has been highlighted by FDG-PET CT in otherwise asymptomatic patients. 

REFERENCES

Parkash O, Sharko A, Farooqi A, Ying GW, Sura P. Acute pancreatitis: a possible side effect of COVID-19 vaccine. Cureus. 2021 Apr 28;13(4).

Dey RK, Ilango H, Bhatta S, Shaheed A, Dole S, Zooshan A, Faisham M, Murad M. Acute pancreatitis in pregnancy following COVID-19 vaccine: a case report. Journal of Medical Case Reports. 2022 Dec;16(1):1-4.

Qurban Z, Mullan D. COVID-19-Related Incidental Pancreatitis Detected on FDG-PET Scan. Cureus. 2022 Nov 21;14(11).

Halsey, Richard, Dimitrios Priftakis, Strachan Mackenzie, Simon Wan, Laura M. Davis, David Lilburn, Andrew Thornton, Nikolaos Papathanasiou, Gopinath Gnanasegaran, and Jamshed Bomanji. "COVID-19 in the act: incidental 18F-FDG PET/CT findings in asymptomatic patients and those with symptoms not primarily correlated with COVID-19 during the United Kingdom coronavirus lockdown." European journal of nuclear medicine and molecular imaging 48, no. 1 (2021): 269-281.

Boskabadi SJ, Ala S, Heydari F, Ebrahimi M, Jamnani AN. Acute pancreatitis following COVID-19 vaccine: A case report and brief literature review. Heliyon. 2023 Jan;9(1):e12914. doi: 10.1016/j.heliyon.2023.e12914. Epub 2023 Jan 14. PMID: 36685416; PMCID: PMC9840226.

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