Marked serum procalcitonin level in response to isolated anaphylactic shock

Mann, Jason; Cavallazzi, Rodrigo

doi:10.1016/j.ajem.2014.05.053

Cited by 14 publications

(19 citation statements)

References 8 publications

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“…13 In fact, very elevated procalcitonin concentrations have been shown in anaphylactic reactions to medications. [14][15][16] With regards to our patient's "sulfa" allergy, nonantibiotic drug molecules with sulfonamide moieties (such as hydrochlorothiazide) do not confer crossreactivity to sulfonamide antibiotic molecules. 17,18 Although a biochemical cross-reactivity does not exist, data suggest that patients with an allergy to sulfonamide antibiotics are likely predisposed to allergic reactions to other molecules, even if those molecules are chemically unrelated.…”

Section: Discussionmentioning

confidence: 94%

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Kane

Cohen²

2017

Perfusion

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Hydrochlorothiazide has been shown to cause rare, but serious non-cardiogenic pulmonary edema. We present a case report of a patient with apparent septic shock and acute respiratory distress syndrome (ARDS) requiring life-sustaining veno-venous extracorporeal membrane oxygenation (VV-ECMO). Upon further review of the literature and the chronology of the patient's presentation, her condition was most likely due to an immune-mediated reaction to hydrochlorothiazide. This represents the first case, to our knowledge, of such a severe reaction to hydrochlorothiazide supported with ECMO therapy.

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Section: Discussionmentioning

confidence: 94%

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Kane

Cohen²

2017

Perfusion

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“…1 It was recently reported that anaphylaxis triggered by drug exposure can also induce a marked elevation in PCT levels. 3,4 In a meta-analysis, PCT had low positive predictive values (17-28%) and high negative predictive values (95-98%) at the 0.5 ng/ml cutoff for bacteremia in adult patients suspected of infection or sepsis. Low PCT levels could be used to rule out bacteremia in different clinical settings.…”

Section: Discussionmentioning

confidence: 98%

Marked elevation of procalcitonin level can lead to a misdiagnosis of anaphylactic shock as septic shock

Kim

Kang

Lee

et al. 2015

International Journal of Infectious Diseases

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The case of a 74-year-old woman who presented with hyperthermia and hypotension is reported. Laboratory test results revealed marked elevation of C-reactive protein (CRP) and procalcitonin (PCT) levels. The clinical presentation and laboratory test results were suggestive of septic shock. No infectious focus was identified. The shock recurred after what was subsequently understood to be an unintended re-challenge with risedronate sodium. Drug-induced anaphylactic shock was finally diagnosed. Anaphylactic shock may be misdiagnosed as septic shock in patients who present with markedly elevated PCT levels.

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“…It should be noted that PCT can be elevated in several conditions such as trauma, pancreatitis, autoimmune diseases and shock, without infection 5. More specifically, there are three reports of elevated PCT in patients with anaphylactic shock 6–8. Physicians should be aware that high PCT levels lack in specificity,5 7 and could lead to misdiagnosis of sepsis in patients with other causes of shock (ie, anaphylaxis).…”

Section: Outcome and Follow-upmentioning

confidence: 99%

“…More specifically, there are three reports of elevated PCT in patients with anaphylactic shock 6–8. Physicians should be aware that high PCT levels lack in specificity,5 7 and could lead to misdiagnosis of sepsis in patients with other causes of shock (ie, anaphylaxis). On the contrary, the negative predictive value of low PCT levels (<0.5 ng/mL) is very high (95%–98%) in excluding bacteraemia 9…”

Section: Outcome and Follow-upmentioning

confidence: 99%

Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock

et al. 2020

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Anaphylaxis represents a systemic disease occurring after the exposure to an allergen. Drugs for the treatment of anaphylactic reactions (ie, corticosteroids and adrenalin) could induce autonomic alterations, such as tachycardia, hyperthermia, tachypnoea and leucocytosis. We describe the case of a 52-year-old woman presenting with a severe allergic reaction after the ingestion of amoxicillin-clavulanate. The occurrence of ECG alterations, laboratory abnormalities and procalcitonin (PCT) elevation will be discussed with particular emphasis on the possible misleading role of PCT during anaphylactic shock.

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Marked serum procalcitonin level in response to isolated anaphylactic shock

Cited by 14 publications

References 8 publications

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Life-threatening idiopathic reaction to hydrochlorothiazide treated with veno-venous extracorporeal membrane oxygenation

Marked elevation of procalcitonin level can lead to a misdiagnosis of anaphylactic shock as septic shock

Electrocardiographic alterations and raised procalcitonin levels during anaphylactic shock

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