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

We propose a new clinical entity termed recovery-phase viral pancreatitis (RVP), characterized by acute pancreatitis arising during the recovery phase of viral infection. RVP frequently develops after apparent symptom improvement or hospital discharge. Although acute pancreatitis associated with viral infections, particularly coronavirus disease 2019 (COVID-19), has been increasingly recognized, most previous studies have focused on pancreatic injury occurring during the acute infectious phase. However, accumulating reports have described pancreatic inflammation and acute pancreatitis arising during apparent clinical recovery and even after hospital discharge. These manifestations are difficult to explain solely by direct viral cytopathic injury during acute infection and instead suggest the presence of a distinct recovery-associated inflammatory process. We performed a focused narrative literature review to identify cases of acute pancreatitis arising during the recovery phase of viral infections. Representative cases demonstrated a reproducible temporal pattern in which pancreatitis developed approximately 1–3 weeks after the onset of viral illness, frequently during convalescence or after hospital discharge. Similar acute pancreatitis during recovery-phase patterns were observed not only in SARS-CoV-2 infection but also in dengue virus, Epstein–Barr virus, and hepatitis A virus infections. Potential mechanisms may involve transient immune suppression during acute viral infection, permitting pancreatic viral infection and antigen persistence. Recovery-associated immune responses may subsequently trigger pancreatic inflammation and acute pancreatitis during the recovery phase or after hospital discharge. Although RVP shares certain conceptual similarities with immune reconstitution inflammatory syndrome (IRIS), it differs in that it appears to arise during the natural course of viral infection without external immune manipulation or profound baseline immunodeficiency. We therefore propose that RVP should be distinguished from classical IRIS.Because RVP may arise even after apparent recovery or hospital discharge, its association with preceding viral infection may be overlooked, leading to potential misclassification as conventional acute pancreatitis. Recognition of RVP may improve clinical awareness of post-viral pancreatic complications.