P0117 - A Rare Case of Paxlovid-Induced Pancreatitis

Jake Debroff, MD¹, Bo Hyung Yoon, MD², Ian Cohen, MD^2
1Mount Sinai Beth Israel, New York, NY; ²Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: With more than 100,000 hospital admissions annually, pancreatitis is a major cause of morbidity and healthcare expenditure both in the country and worldwide. Due to the increasing number of pharmacological advancements, the World Health Organization reports more than 500 drugs can cause drug-induced pancreatitis (DIP). New antiviral agents have been rapidly approved for widespread distribution due to COVID-19. One of which, Paxlovid, is a combination of two antivirals- nirmatrelvir and ritonavir. Paxlovid has been approved for use in preventing hospitalization and mortality among COVID-19 patients. The authors present a rare case of Paxlovid-induced pancreatitis.

Case Description/Methods: A 71-year-old male with past medical history of hyperlipidemia, pre-diabetes, kidney stones, small intestinal bacterial overgrowth, and lactose intolerance presented to the emergency department (ED) with 3 days of epigastric abdominal pain and a 5-pound weight loss during the previous week. One week prior to his ED visit he tested positive for COVID-19 and the only symptom was a dry cough. He subsequently received a 5-day course of Paxlovid for mild COVID-19. One day following completion of Paxlovid, he began having abdominal pain and went to an urgent care clinic. Physical exam revealed tenderness to palpation in the upper abdomen. Bloodwork revealed normal liver function, white blood cell count of 17.8 K/uL, and elevated lipase of 509 U/L. His symptoms did not resolve within the next 24 hours and the following day in the ED his bloodwork showed leukocytosis improved to 14.6 K/uL. CT abdomen/pelvis was significant for mild peripancreatic fat stranding, most notably surrounding the distal pancreas body and tail suggesting acute pancreatitis (Figure 1). The patient received intravenous fluids, and when he was able to tolerate food and oral medications, he was discharged to follow up with his outpatient gastroenterologist.

Discussion: Paxlovid is a commonly used COVID-19 medication made up of nirmatrelvir and ritonavir. Underlying mechanisms for novel COVID-19 treatments causing pancreatitis have been limited, but a link between protease inhibitors (PI) and acute pancreatitis has been reported. Ritonavir has been identified as one of the potential drugs which can cause pancreatitis in several case reports. Our case report raises the awareness of the rare complication of pancreatitis from Paxlovid which has been utilized frequently with COVID-19 pandemic effects.



Disclosures:


Jake Debroff, MD¹, Bo Hyung Yoon, MD², Ian Cohen, MD². P0117 - A Rare Case of Paxlovid-Induced Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.