This patient is a 52-year-old female with a history of type 2 diabetes, hypertension, hypothyroidism, and morbid obesity. Over the course of a week, the patient experienced fever, a dry cough, and shortness of breath before testing positive for SARS-CoV-2 via a nasopharyngeal swab, as detected by RT PCR with a cycle threshold value of 24.
When asked for a more detailed history, the patient stated that she had abdominal pain for at least a week and was initially treated as gastritis. However, the severity was gradually increasing. The pain was primarily epigastric, affecting the right upper quadrant, burning in nature, frequently radiating to the back, and was exacerbated by oral intake.
Presenting Symptoms
On initial presentation, the patient denied having abdominal pain. The patient was admitted to an isolation facility in accordance with national protocols for mildly symptomatic patients who are unable to be isolated at home. On the sixth day, she developed a worsening cough and shortness of breath due to hypoxia and was transferred to a treatment facility for moderate pneumonia cases. Chest radiograph showed infiltrates bilaterally, and so she was treated as per COVID-19 pneumonia therapy protocols.
Treatment
In addition to her regular home medications, the patient was started on a 15-day steroid course (including dexamethasone and methylprednisolone), ceftriaxone, doxycycline, azithromycin, enoxaparin, vitamin D, zinc, fluticasone furoate/vilanterol, salbutamol, ipratropium bromide, pantoprazole, omeprazole, metoclopramide. Proning and incentive spirometry were also used. The patient needed oxygen delivered through a nasal cannula and a face mask.
Outcome
As the pneumonia was clearing up and the patient was getting ready to be discharged, she began to experience abdominal pain. She had previously tested negative for COVID on two nasopharyngeal swabs obtained as exit swabs on days 17 and 18 following the initial swab. An abdominal CT scan revealed an atrophic pancreas with diffuse fatty infiltration, minimal peripancreatic fat stranding, fluid accumulation and reactive lymph nodes.
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