key: cord-0978115-gbn3cnre
authors: Schepis, T.; Larghi, A.; Papa, A.; Miele, L.; Panzuto, F.; De Biase, L.; Annibale, B.; Cattani, P.; Rapaccini, G.L.
title: SARS-CoV2 RNA detection in a pancreatic pseudocyst sample
date: 2020-05-28
journal: Pancreatology
DOI: 10.1016/j.pan.2020.05.016
sha: 805f404abf9ea015f2f4188da335d8a942e1845c
doc_id: 978115
cord_uid: gbn3cnre

The involvement of gastrointestinal system in SARS-CoV2 related disease, COVID-19, is increasingly recognized. COVID-19 associated pancreatic injury has been suggested, but its correlation with pancreatic disease is still unclear. In this case report, we describe the detection of SARS-CoV2 RNA in a pancreatic pseudocyst fluid sample collected from a patient with SARS-CoV2 associated pneumonia and a pancreatic pseudocyst developed as a complication of an acute edematous pancreatitis. The detection of SARS-CoV2 within the pancreatic collection arise the question of whether this virus has a tropism for pancreatic tissue and whether it plays a role in pancreatic diseases occurrence.

. The occurrence of pancreatic injury, defined as increasing in amylase and lipase levels, has been described in 17% of 52 patients admitted for COVID-19 pneumonia [3] . ACE 2 receptor, used from the virus to penetrate cells, is widely expressed in the digestive system and in pancreatic cells, thus suggesting a tropism of SARS-CoV2 for pancreatic tissue [4] [5] [6] . However, the cytopathic effect of SARS-CoV2 on pancreas is still unclear since the virus isolation on pancreatic tissue or pancreatic juice has not been reported so far.

In April 2020, a 67-years-old woman referred to our department complaining of fever, upper quadrant abdominal pain and vomiting. Her medical history included a recent hospitalization for interstitial edematous acute pancreatitis of unknown origin. On admission, the abdomen appeared distended with a slight tenderness and pain in epigastric and mesogastric regions. Laboratory tests showed an increasing in inflammatory proteins and normal level of pancreatic enzymes and white blood cells. An abdomen CT scan showed the presence of a large pancreatic pseudocyst (16 cm x 8 cm x 12 cm) causing a partial stomach outlet obstruction, Figure 1a , and a chest CT scan documented bilateral and multiple mottling and "ground glass" opacities, Figure 1c . The potential role of coronaviruses on pancreatic diseases has been shown in the past, in fact SARS-CoV was detected in pancreatic cells and its direct cytopathic effect was hypothesized [7] . Herein we reported, for the first time in literature, a qualitative and quantitative detection of SARS-CoV2 RNA in the fluid of a pancreatic collection, opening to different scenarios: SARS-CoV2 might have a tropism for pancreatic cells leading to a direct cytopathic effect, otherwise the presence of SARS-CoV2 in the pancreatic collection might occur secondarily using other cells (e.g. the inflammatory cells) as Trojan horses or as a retrograde contamination from the intestinal tube. In conclusion, the presence of SARS-CoV2 RNA in a pancreatic collection endorse the involvement of GI system in COVID-19 and may affect our clinical practice. Nevertheless, further studies are needed to clarify the exact role of SARS-CoV2 in causing pancreatic disease. 

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ST performed data collection. LA performed the endoscopic procedure. CP performed the virologic tests. ST and RGL drafted the manuscript. All authors discussed the results and contributed to the final manuscript. Funding: None declared Conflict of interest: A. Larghi: training and fees for Boston Scientific, Medtronic and Pentax. All other authors disclosed no conflict of interest