Systemic Inflammatory Syndrome and Hepatic Inflammatory Cell Infiltration Caused by an Interleukin-6 Producing Pheochromocytoma

Abstract

Abstract. Pheochromocytoma is a tumor that produces a variety of biologically active substances in addition to catecholamines. We report here a patient with a pheochromocytoma, who presented with acute inflammatory symptoms and marked abnormalities in liver function and hematological tests. A 31-year-old man, who had experienced intermittent fever, chills and weight 1oss during the previous several months, was referred to our hospital for further evaluation. Laboratory examination revealed anemia, leukocytosis with elevated inflammatory markers, and abnormalities in coagulation and liver function tests. Histological examination revealed a marked plasmacytosis in the bone marrow and lymphocyte infiltration into the portal area of the liver. Along with increases in serum catecholamine and urine catecholamine metabolites, his serum interleukin (IL)-6 level was increased to 300 pg/ml, compared with a normal range of 3-12 pg/ml. Left adrenalectomy was performed. The adrenal tumor was densely immunostained with antibody to IL-6. After resection of his adrenal tumor, his serum IL-6 level returned to normal (11 pg/ml) and all symptoms subsided with normalization of laboratory findings.

Continuous renal replacement therapy for haemodynamic collapse and rhabdomyolysis induced by pheochromocytoma crisis

“…The clinical presentation of hyperpyrexia could easily be mistaken for septicaemia, but infection was an unlikely underlying cause as a result of the ineffectiveness of a wide range of strong antibiotics. The fever and acute inflammatory symptoms could be explained by the production of interleukin‐6 by the tumour, as reported previously 9. The patient presenting with dyspnoea, paroxysmal hypertension and hypotension, sinus tachycardia, low LV ejection fraction, and increased cTnI and ST‐T wave changes had extremely unstable haemodynamics that could be explained by cardiac shock or catecholamine cardiomyopathy.…”

Emergencies Caused by Pheochromocytoma, Neuroblastoma, or Ganglioneuroma

“…The clinical presentation can be mistaken for septicemia, in which case appropriate treatment is delayed [5,7,10,[12][13][14]. Fever and acute inflammatory symptoms may be due to interleukin-6 production by the tumor [15]; therefore, a pheochromocytoma should be included in the differential diagnosis if a patient with suspected septicemic shock is refractory to fluid and inotropic agents.…”

Pheochromocytoma presenting with rhabdomyolysis and acute renal failure: a case report

“…Fever and acute inflammatory symptoms may be due to interleukin-6 production by the tumor, similar to findings in our patient. 11 There have also been a few case reports linking acute renal failure to pheochromocytoma. [6][7][8] Many of the patients involved had evidence of muscle damage with elevated CK levels, but elevated urinary myoglobin levels were not confirmed in any of the cases.…”