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Case Reports in Infectious Diseases

Volume 2023, Article ID 9965435, 4 pages
https://doi.org/10.1155/2023/9965435

Case Report
A Case Report of Acute Severe Necrotizing Pancreatitis following
the Johnson & Johnson Vaccine against the Novel SARS-CoV-2

Ayrton I. Bangolo ,1 Mahabuba Akhter,1 Auda Auda,1 Rahina Akram,1

Vignesh K. Nagesh,1 Donnee Athem,1 Reenu Thomas,1 Ligaya Tibalan,1 Mansi Trivedi,1
Saima Mushtaq,1 Neha Singh,1 Pracheta Bagale,1 Georgemar V. Arana Jr.,1 Tayyaba Khan,1
Shelja Sharma,1 Swetha Mynedi,1 Dhara D. Patel,1 Mandeep Saini,1
Madhurya R. Chinthakuntla,1 Kareem Ahmed,2 Mary Gad,1 Srikara Dheer D. R. Gondhi,1
Georgemar Arana,1 Rohini B. Gurumoorthy,1 and Simcha Weissman 1
1
Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ, USA
2
Department of Internal Medicine, University of Washington, Seattle, Washington, USA

Correspondence should be addressed to Ayrton I. Bangolo; ayrtonbangolo@yahoo.com

Received 24 November 2022; Revised 26 February 2023; Accepted 16 March 2023; Published 22 March 2023

Academic Editor: Piyush Baindara

Copyright © 2023 Ayrton I. Bangolo et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Acute pancreatitis is an infammatory condition, which is a leading gastrointestinal cause of hospitalization in the United States.
Several conditions are associated with acute pancreatitis. More recently, there have been a few cases reported of acute pancreatitis
following the Pfzer-BioNTech COVID-19 mRNA vaccine. To our knowledge, no cases of acute pancreatitis have been yet
reported following the Johnson & Johnson’s Janssen COVID-19 vaccine (J& J vaccine). Herein we report a 34-year-old male with
no signifcant past medical history admitted with acute necrotizing pancreatitis, the day following the receipt of the J&J vaccine.
Based on the Naranjo and the modifed Naranjo scale, the patient met the requirements for probable drug induced pancreatitis.
Tis case report has the objective to raise awareness of a potentially severe side efect of the J&J vaccine. We hope to use this case to
support screening all patients for previous history of acute pancreatitis before administration of the J& J vaccine.

1. Introduction cases of acute necrotizing pancreatitis associated with the

Johnson& Johnson’s Janssen COVID-19 vaccine (J&J vac-
Acute pancreatitis is an acute infammatory process of the cine) have yet been reported in the literature. Herein we
pancreas with a mortality rate of 17 percent in patients who report the case of a young, nonalcoholic male who presented
develop pancreatic necrosis [1]. About two-thirds of acute with severe abdominal pain, the day following receipt of the
pancreatitis cases are associated with gallstones and chronic J&J vaccine. He was admitted with acute necrotizing pan-
alcohol use disorders [2]. Acute pancreatitis following creatitis and an extensive work up did not yield an alter-
vaccinations, such as the Human Papillomavirus vaccine has native etiology. Tis case report highlights a potentially
been previously reported in the literature [3]. More recently, severe side efect of the J&J vaccine. We propose that ad-
a few cases of acute necrotizing pancreatitis have been linked ministration of the J&J vaccine is a risk factor for acute
to the Pfzer-BioNTech COVID-19 mRNA vaccine [4, 5]. No necrotizing pancreatitis.
2 Case Reports in Infectious Diseases

Table 1: Laboratory values on admission.

Laboratory values
(normal values)
White blood cells 18.9 × 10 ∗ 3 (4.8–10.8 × 10 ∗ 3) microliter (μL)
Neutrophils 86% (45–70)
Blood urea nitrogen 45 (7–25) milligram per deciliter (mg/dL)
Creatinine 2.19 (0.7–1.30) mg/dL
Calcium 7.3 (8.6–10.3) mg/dL
Albumin 3.5 (3.5–5.7) gram per deciliter (g/dL)
Aspartate aminotransferase 91 (13–39) unit per liter (U/L)
Alanine aminotransferase 85 (7–52) U/L
Alkaline phosphatase 48 (34–104) U/L
Triglycerides 260 (<150) mg/dL
Total bilirubin 9.9 (0.3–1) mg/dL
Ceruloplasmin 35 (18–36) mg/dL
Lipase 1,026 (11–82) U/L
Antiliver/kidney microsomal antibodies <�20 (<�20)
Immunoglobulin G 846 (600–1640) mg/dL
Antinuclear antibody Negative
Actin antibodies <20 (≤20) units (U)
Antimitochondrial antibody Negative
C-reactive protein 20 millimeter per hour (0–15)
Abnormal lab values are in bold.

2. Case Report
Tis is a 34-year-old male with no signifcant past medical
history and not taking any medications who presented for
evaluation of a 1-day history of severe constant epigastric
pain, radiating to the back. He reported associated nausea
with 2 episodes of nonbloody, nonbilious vomiting, sub-
jective fever, and chills. Of note, the patient received the J&J
vaccine the day prior to presentation. He denies any tobacco
use, and reports drinking on social occasions. His last drink
was 2 weeks prior to the presentation. He denies any pre-
vious similar episodes or any association with food. Of note,
prior to vaccination administration, the patient tested
negative for COVID-19 by reverse transcription-polymerase
chain reaction. Figure 1: Computed tomography of the abdomen and pelvis
On physical exam, he was found to be tachycardic, di- showing necrotizing pancreatitis (green arrow).
aphoretic, and febrile with a temperature of 100.9 Fahrenheit.
Te abdomen was tender in all 4 quadrants, more so in the 3. Discussion
epigastric area. His laboratory results revealed leukocytosis,
elevated lipase, and elevated liver enzymes as seen in Table 1. Acute pancreatitis is an infammatory condition of the
Te computed tomography (CT) of the abdomen and pelvis pancreas characterized by abdominal pain and elevated
was consistent with acute necrotizing pancreatitis (Figure 1). levels of pancreatic enzymes. Several conditions are asso-
Te right upper quadrant ultrasound showed a patent portal ciated with acute pancreatitis. Gallstones and chronic al-
vein and no signs of acute cholecystitis. Additional laboratory cohol use disorders are the etiology for most cases [6].
studies to further investigate the etiology of acute pancreatitis Several vaccines have been reported in the literature as
were within normal limits (Table 1). potential etiology of acute pancreatitis [3, 7, 8]. More re-
Te patient was admitted to the Intensive Care Unit, cently, a few cases of vaccine induced necrotizing pancre-
started on Lactated Ringer and pain medications. In- atitis have been reported with the Pfzer-BioNTech
fectious disease and gastroenterology were consulted, and COVID-19 mRNA vaccine [4, 5]. Te J&J vaccine has been
the patient was started on empiric meropenem. Te pa- associated with a few adverse events, among which deep-
tient’s hospital course was complicated with ileus and vein thrombosis [9]∗ . Te Naranjo scale was developed to
duodenal perforation for which he underwent an emer- help standardize assessment of causality for all adverse drug
gent exploratory laparotomy. He was discharged after reactions including vaccines [10]. Our patient is a healthy
30 days of hospitalization. young male, with no other risk factors for acute pancreatitis,
Case Reports in Infectious Diseases 3

and with symptoms onset the day following the receipt of the Conflicts of Interest
vaccination. He scored 5 on the Naranjo scale, consistent
with probable association of necrotizing pancreatitis with Te authors declare that they have no conficts of interest.
the vaccine.
Increased alkaline phosphatase and total bilirubin levels Authors’ Contributions
have been historically used in prediction of biliary pan-
creatitis [11]. However, a study by Bradley and Salam found Ayrton I Bangolo searched the literature and wrote and
hyperbilirubinemia in up to 47 percent of patients with acute revised the manuscript. Mahabuba Akhter, Auda Auda,
pancreatitis without biliary obstruction [12]. Paralytic ileus Rahina Akram, Vignesh K. Nagesh, Donnee Athem, Reenu
has been reported in the literature as a complication of acute Tomas, Ligaya Tibalan, Mansi Trivedi, Saima Mushtaq,
pancreatitis [13]. Spontaneous bowel perforation can be Neha singh, Pracheta Bagale, Georgemar V. Arana Jr,
a rare and life-threatening complication of acute necrotizing Tayyaba Khan, Shelja Sharma, Swetha Mynedi, Dhara
pancreatitis [14]. Our patient had signifcant hyper- D. Patel, Mandeep Saini, Madhurya R. Chinthakuntla,
bilirubinemia, although the liver and biliary imaging did not Kareem Ahmed, Mary Gad, Srikara Dheer D. R. Gondhi,
reveal any stones or signs of obstruction. His pancreatitis Georgemar Arana1, and Rohini B. Gurumoorthy revised and
was complicated with ileus and duodenal perforation which edited the manuscript. Simcha Weissman approved the fnal
are rare complications. We encourage clinicians to include version and is the article’s guarantor. All authors certify that
these complications in the diferential of any worsening they contributed sufciently to the intellectual content and
clinical course of acute pancreatitis. data analysis. Each author has reviewed the fnal version of
Te mainstay of management of a patient with acute the manuscript and approves it for publication.
pancreatitis consists of supportive care with fuid resuscitation,
pain control, and nutritional support [15]. Clinical signs of
infection and abdominal imaging demonstrating the presence References
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