AJCC
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

American Journal of Critical Care. 2010;19: 96-93 doi:10.4037/ajcc2009805
Copyright © 2010 by the American Association of Critical-Care Nurses.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
ajcc2009805v1
19/1/96    most recent
Right arrow Respond to This Article
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Google Scholar
Right arrow Articles by Schumm, J.
Right arrow Articles by Figulla, H. R.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Schumm, J.
Right arrow Articles by Figulla, H. R.
Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc{at}aacn.org.

An Unusual Case of Progressive Shock and Highly Elevated Procalcitonin Level

By Julia Schumm, MD, Rüdiger Pfeifer, MD, Markus Ferrari, MD, Friedhelm Kuethe, MD and Hans R. Figulla, MD. Julia Schumm, Rüdiger Pfeifer, Markus Ferrari, Fried-helm Kuethe, and Hans R. Figulla are all physicians in the Department of Internal Medicine I, Friedrich-Schiller-University Jena, Jena, Germany.

Corresponding author: Dr med Julia Schumm, Department of Internal Medicine I, Erlanger Allee 101, D-07740 Jena, Germany (e-mail: julia.schumm{at}med.uni-jena.de).

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.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2010 by the American Association of Critical-Care Nurses.