title: An unusual case of progressive shock and highly elevated procalcitonin level.
abstract: A 21-year-old man with signs and symptoms of rapidly progressive shock was admitted to the intensive care unit for treatment of suspected sepsis. Levels of inflammatory markers (including procalcitonin) were highly elevated, but no obvious focus of infection was apparent. Initial sepsis therapy included administration of broad-spectrum antibiotics, vasoconstrictors, and drotrecogin alfa. Cultures of blood, sputum, and urine showed no growth, and no viruses were detected. The random (no stimulation with corticotropin) cortisol level at admission was less than 25 nmol/L. Assays for autoantibodies to the adrenal cortex were strongly positive and confirmed the diagnosis of adrenal failure caused by Addison disease. After initiation of steroid therapy, the patient fully recovered. Although increased procalcitonin levels are considered a reliable and specific indicator of severe generalized infections and bacterial sepsis, elevated procalcitonin levels cannot be relied on when trying to differentiate between addisonian crisis and septic shock.
authors.affiliation: Department of Internal Medicine I, Friedrich-Schiller-University Jena, Germany. julia.schumm@med.uni-jena.de
authors.forename: Julia
authors.initials: J
authors.lastname: Schumm
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Pfeifer
authors.forename: Markus
authors.initials: M
authors.lastname: Ferrari
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Kuethe
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000224:Addison Disease / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003937:Diagnosis, Differential; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011486:Protein C / Q000627:therapeutic use; D011498:Protein Precursors / Q000097:blood*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012772:Shock, Septic / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D013256:Steroids / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D005343:Fibrinolytic Agents; D011486:Protein C; D011498:Protein Precursors; D011994:Recombinant Proteins; D013256:Steroids; D014662:Vasoconstrictor Agents; D002116:Calcitonin; C421124:drotrecogin alfa activated; D015740:Calcitonin Gene-Related Peptide