Letters To The Editor

Enterovirus D-68 presenting with acute pancreatitis

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To the Editor: We read the review on enterovirus D68 1 (EV-D68) with great interest, and we thought it merited comment.

During the current influenza season, we have had several adult cases of EV-D68 presenting as an influenza-like illness. EV-D68 was diagnosed by nasal swab viral film array polymerase chain reaction (PCR) testing. We agree with the authors that the clinical spectrum of enteroviral infection includes a variety of extraintestinal manifestations, eg, acute pancreatitis. As more cases of EV-D68 are described, the range of clinical manifestations will be increased. 2–5

We recently saw a 27-year-old woman who presented with an influenza-like illness, but with a main complaint of right-upper-quadrant abdominal pain. She denied recent travel or contacts with sick children or adults. Her past medical history was unremarkable, and she was not taking any medications. The physical examination was unremarkable except for moderately severe tenderness in the right upper quadrant, with no rebound or guarding.

Results of laboratory testing at hospital admission included a white blood cell count of 7.3 × 10 9/L (49% neutrophils, 41% lymphocytes, 7% monocytes, 3% eosinophils), a normal platelet count, serum lipase 73 U/L (reference range 5.6–51.3 U/L), and serum amylase 211 U/L (37–121 U/L). Serum aminotransferase and alkaline phosphatase levels were normal. Abdominal ultrasonography was unremarkable. Nasal swab for multiplex PCR testing for respiratory viruses was positive for human rhinovirus-enterovirus. Further PCR testing was positive for EV-D68 (New York State Department of Health, Wadsworth Laboratory). Her abdominal pain was treated symptomatically; she gradually improved and was discharged.

This instance of EV-D68 in a healthy 27-year-old woman presenting with influenza-like illness and acute pain in the right upper quadrant is the first we have seen of EV-D68 presenting as acute pancreatitis. Clinicians should be aware that EV-D68, like influenza, may present with gastrointestinal manifestations.

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