Arce Gastelum Alheli, Volberding Thomas, Freeman S Caleb, Dick Mary, Gbadamosi-Akindele Maryam
Internal Medicine, Creighton University School of Medicine, Omaha, USA.
Dermatology, Creighton University School of Medicine, Omaha, USA.
Cureus. 2020 May 20;12(5):e8215. doi: 10.7759/cureus.8215.
Historically, elevations in procalcitonin (PCT) have been implicated in medullary thyroid cancer and neuroendocrine tumors. More recently, the trending of PCT has been suggested as a monitor of infection to assess the presence, clearance and eradication of infection, especially in cancer patients. Its increase serves as a marker of bacterial infections. During homeostasis it is produced by most tissues in the body at an extremely low level (<.01 ng/mL) and is often induced by bacterial endotoxins. In cancer patients additional factors influence these levels. Metastasis in particular is linked with relatively higher PCT levels. We present a case of an afebrile patient with undifferentiated pleomorphic sarcoma who underwent 25 cycles of radiation therapy and presented one month later with elevated procalcitonin, lactic acid, and leukocytosis. All infectious work up was negative. Findings were incidental after a hospital visit for dehydration. Leukocytosis and lactic acidosis resolved after four days into the hospitalization. Procalcitonin, however, remained elevated over four months in the range of 2-5 ng/mL. The patient has no findings of metastatic disease. To our knowledge, there has never been a report in the literature describing a prolonged elevation of procalcitonin in a patient with a non-metastatic sarcoma without any signs of infection or any other underlying cause. The elevation of PCT has been noted in patients who suffered burns, trauma, minor and major surgery, and cardiogenic shock in addition to infection. Increases have served as signs of worsening patient outcomes and elevated rate of complications. Trending PCT can help in appropriated antibiotic use as it has been shown to decrease antibiotic use by 2.4 days. PCT trends have been increasing in value making idiopathic elevations found in combination undifferentiated pleomorphic sarcoma an important addition to the literature.
从历史上看，降钙素原（PCT）升高与甲状腺髓样癌和神经内分泌肿瘤有关。最近，有人提出监测PCT的变化趋势可用于评估感染情况，以判断感染的存在、清除和根除情况，尤其是在癌症患者中。其升高是细菌感染的一个标志。在体内稳态时，身体大多数组织产生的PCT水平极低（<0.01 ng/mL），且常由细菌内毒素诱导产生。在癌症患者中，其他因素也会影响这些水平。特别是转移与相对较高的PCT水平有关。我们报告一例未分化多形性肉瘤患者，该患者无发热，接受了25个周期的放射治疗，一个月后出现降钙素原、乳酸升高及白细胞增多。所有感染相关检查均为阴性。这些发现是在因脱水住院检查时偶然发现的。住院四天后白细胞增多和乳酸酸中毒得到缓解。然而，降钙素原在四个多月的时间里一直升高，范围在2 - 5 ng/mL。该患者没有转移性疾病的迹象。据我们所知，文献中从未有过关于非转移性肉瘤患者降钙素原长时间升高且无任何感染迹象或其他潜在原因的报道。除感染外，烧伤、创伤、大手术和心源性休克患者也会出现PCT升高。PCT升高是患者预后恶化和并发症发生率增加的标志。监测PCT变化趋势有助于合理使用抗生素，因为已证明它可使抗生素使用天数减少2.4天。PCT变化趋势的价值日益凸显，在未分化多形性肉瘤患者中发现的特发性升高为文献增添了重要内容。
