POST-COVID-19 CHRONIC FATIGUE SYNDROME WITH ACUTE PANCREATITIS AND TRANSIENT HYPERZINCEMIA

Abstract

INTRODUCTION/BACKGROUND
Chronic fatigue syndrome (CFS) often follows viral infections, including COVID-19. Long COVID is increasingly recognized as a cause of post-viral fatigue. While rare, hyperzincaemia has been linked to acute pancreatitis. This case explores the interplay between post-viral fatigue, metabolic disturbances, autonomic dysfunction, and transient hyperzincaemia in acute pancreatitis.

CASE
A 61-year-old male with hypertension, benign prostatic hyperplasia, hepatosteatosis, and gallstone-induced acute pancreatitis presented with persistent fatigue post-COVID-19. Clinical evaluation included metabolic, endocrine, and nutritional markers, focusing on zinc, copper, ceruloplasmin, thyroid, and adrenal function. Autonomic function and post-exertional fatigue patterns were assessed.

The patient developed persistent fatigue following his third and most severe COVID-19 infection, which required hospitalization. Fatigue worsened with exertion and was not relieved by rest. Gallstone-related acute pancreatitis revealed transient hyperzincaemia (serum zinc: 153 mcg/dL, reference: 60-106 mcg/dL) with normal copper, ceruloplasmin, and adrenal function (AM cortisol: 196 nmol/L).

Possible mechanisms include transient zinc release from pancreatic tissue due to acinar cell destruction, reduced zinc excretion resulting from impaired clearance due to the presence of hepatic dysfunction and potential renal impairment, gallstone-related factors such as the presence of cholestasis leading to decreased biliary excretion, altered zinc distribution due to systemic inflammation, exogenous sources leading to contamination or artifacts arising from measurement errors.

Fatigue improved with nil by mouth but recurred post-discharge. Blood pressure fluctuations during this period suggest possible autonomic or even beginning adrenal dysfunction. Hyperzincaemia resolved with dietary modifications.

CONCLUSION
Post-COVID-19 fatigue requires a thorough metabolic, endocrine, and autonomic evaluation. This case highlights transient hyperzincaemia in acute pancreatitis and the need for cautious interpretation of trace element abnormalities. Understanding zinc metabolism and autonomic dysfunction may offer insights into post-viral fatigue syndromes.