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Pancreatitis, pregestational diabetes and hyperchylomicronia in a pregnant woman with COVID-19

Ahead of print available from 21/06/2022
These articles are scheduled for publication in Vol. 85 (4) 2022

Author(s) S. Laurijssen 1 #, C. Blanchaert 1 #, ThB (Marcel) Twickler 2, K. Dam 3
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(1) University of Antwerp, Faculty of Medicine, Antwerp, Belgium
(2) AZ Monica, Department of Endocrinology, Antwerp, Belgium
(3) AZ Monica, Department of Gynaecology, Antwerp, Belgium
(#) Contributed equally

A 37-year-old pregnant woman, was diagnosed with acute pancreatitis whilst being infected with COVID-19. Additionally, she had a hyperchylomicronemia and an uncontrolled (most probably, pre-gestational) type 2 diabetes. The coronavirus is able to enter the pancreatic cells through ACE-2 receptors. On the pancreatic level, ACE- 2 receptor expression is present but not as abundant as on pulmonary level. However, with inflammation (due to hyperchylomicronemia), the ACE-2 receptor expression may change and hypothetically make the pancreas more susceptible for a Covid-19 surinfection. Here it is difficult to conclude whether the COVID-19 infection contributed substantially to the development of pancreatitis. Late term pregnancy, uncontrolled glycaemia and the heterozygote mutation in the GPIHBP1 gene (c.523G>C p; Gly175Arg), all contribute to increased TG levels, a principal factor in the development of pancreatitis. This case shows a rare but serious clinical presentation late in pregnancy that could have interesting consequences postpartum.

Keywords: pancreatitis, COVID-19, pregestational diabetes, hyperchylomicronemia, GPIHBP1 gene
© Acta Gastro-Enterologica Belgica.