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[Unusual cause of a PCT-elevation]
Laura Clarissa Vogelbacher1, Robert Thimme1
1Klinik für Innere Medizin II, Universitätsklinikum Freiburg.
Introduction:
Procalcitonin (PCT) is an established marker for bacterial infection. Elevation of PCT can occur due to various reasons and is not specific, as we outline in the following case report.
History:
We report on a 29 year old patient, who was presented by the psychiatric department because of obscure abdominal pain, nausea and vomiting since two days. Taking the patients history did not result in conclusive findings at first.
Findings And Diagnosis:
The clinical examination did not result in conclusive findings. The patient was afebrile. Blood work showed an elevation of transaminases and a massive elevation of PCT. In ultrasound no abnormalities were shown, serological investigations for viral hepatitis were negative. Blood cultures remained sterile, the search for an infectious focus remained unremarkable.
Therapy And Course:
In the course of the in-patient stay the patient reported the ingestion of approximately 40 g of acetaminophen in suicidal intention two days before. Therapy with N-acetylcysteine (NAC) was initiated. The transaminases and PCT were regressive the next day. Antibiotic therapy was foregone.
Conclusions:
This case illustrates that PCT-elevation is not specific for a bacterial infection and must be seen in correlation to patient's history and clinical findings.
Insights
Procalcitonin (PCT) elevation can occur in non-bacterial conditions. This case highlights PCT elevation due to acetaminophen overdose, not infection, emphasizing clinical correlation.
Area of Science:
- Clinical Biochemistry
- Toxicology
- Infectious Disease Diagnostics
Background:
- Procalcitonin (PCT) is a biomarker commonly used to indicate bacterial infections.
- PCT elevation is not always specific and can be influenced by various non-infectious factors.
Observation:
- A 29-year-old patient presented with abdominal pain, nausea, and vomiting.
- Initial investigations revealed elevated transaminases and significantly elevated PCT levels.
- Standard infectious workup, including blood cultures and viral hepatitis serology, was negative.
Findings:
- The patient self-reported acetaminophen overdose.
- Initiation of N-acetylcysteine (NAC) therapy led to the regression of transaminases and PCT levels.
- Antibiotics were not administered, and the patient recovered.
Implications:
- This case underscores that PCT elevation is not pathognomonic for bacterial infections.
- PCT levels must be interpreted within the broader clinical context, including patient history and other diagnostic findings.
- Awareness of non-infectious causes of PCT elevation is crucial for appropriate patient management and avoiding unnecessary antibiotic use.
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