Procalcitonin als Marker der schweren Sepsis bei einer immunsupprimierten Patientin

Abstract

A 22 year old female was admitted to the emergency department with high fever up to 41,5 degrees C, tachycardia, and arterial hypotension. Clinically, she presented with bilateral pulmonary coarse crackles. Diagnosis on admission was pneumonia with septic shock. Intriguingly, procalcitonin (PCT) was increased early, reaching up to 435 ng/mL, while C-reactive protein levels were only moderately increased, with several days delay. The sepsis was originated from a multi-resistant pseudomonas aeruginosa pneumonia. Remarkably, the course of PCT levels reflected the severity of septic shock in that it paralleled noradrenaline demand. Ten months previously, the patient had been diagnosed with acute disseminated brainstem encephalitis (ADEM), and had received two cycles of intravenous cyclophosphamide. Our case illustrates that PCT is an early marker for sepsis and it indicates that PCT may also be a valuable marker for the severity of sepsis in immunosuppressed patients.

Immune regulation of procalcitonin: a biomarker and mediator of infection

“…Further, Linscheid and colleagues [35] were unable to detect production of PTC mRNA in LPS-activated macrophages or in freshly isolated PBMC, yet a transient expression could be induced following monocytes adhesion [36]. Several investigators showed an increased serum PCT in neutropenic patients [37][38][39], as well as immunodeficient patients [40,41], emphasizing an indispensable role for hematopoietic cells in induction of PCT. The fact that leukopenia had no influence on the rise of PCT on admission to day 2 for sepsis patients with immunosuppression may confirm these conclusions [42].…”