Recovery-Phase Viral Pancreatitis (RVP): Proposal of a New Clinical Framework Arising During the Natural Course of Viral Infection

We propose recovery-phase viral pancreatitis (RVP) as a new clinical framework for acute pancreatitis arising during natural recovery from viral infection. Although pancreatic injury during acute viral illness has been widely reported, pancreatitis arising after improvement of systemic viral symptoms remains poorly characterized. We conducted a focused narrative review with descriptive case-level analysis of published reports of virus-associated acute pancreatitis. We identified 19 cases of recovery-phase pancreatitis involving multiple unrelated viruses, including SARS-CoV-2, dengue virus, hepatitis A virus, and Epstein–Barr virus, although most cases (13/19, 68%) were associated with SARS-CoV-2. We propose a hypothetical two-hit model in which possible pancreatic viral involvement or antigen persistence during acute infection (Hit 1) is followed by recovery-associated immune recognition and pancreatic inflammation (Hit 2). Though RVP may share pathophysiological features with classical immune reconstitution inflammatory syndrome (IRIS), we believe it should be distinguished from IRIS because it arises during the natural course of viral infection. RVP has been described after hospital discharge and may therefore represent an underrecognized temporal association, in which its relationship to the preceding viral infection may be overlooked. Recognition of RVP may facilitate appropriate diagnosis of pancreatitis arising during recovery from viral infection and provide a framework for future mechanistic investigations.