Luo Peiyi, Long Yanqiong, Ma Liang, Tao Ye, Gou Shenju
Department of Nephrology, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
Infect Drug Resist. 2022 Sep 2;15:5161-5166. doi: 10.2147/IDR.S378894. eCollection 2022.
The elevation of serum procalcitonin (PCT) has been considered as a marker of systemic bacterial infection and sepsis. However, the marked elevation of PCT in non-sepsis conditions was rare. Here, we report a rare case of sustained markedly elevation of serum PCT in a dialysis patient with tuberculosis, but without the evidence of sepsis.
A 25-year-old man on maintenance hemodialysis was admitted to the hospital for kidney transplantation. On admission, physical examination revealed multiple lymph nodes were palpable on both sides of the neck which was later confirmed as tuberculosis with biopsy pathology. On the 3rd day after admission, the patient suffered from fever with a temperature of 38.8°C. The white blood cells 12.35 × 10/L and the PCT level was 5.73 ng/mL. Lately the PCT increased to 63.10 ng/mL, and the level of C-reactive protein was 186.00 mg/L. After the antibiotics upgraded from cefmetazole to meropenem, and vancomycin was added, the body temperature dropped to the normal range on the 17th day and remained normal thereafter. The PCT level declined gradually to 4.18 ng/mL on the 21st day and an antituberculosis regimen was started. After that, the PCT levels fluctuated between 2.9 ng/mL and 94.9 ng/mL without any manifestation of sepsis. The markedly elevation of serum PCT level persisted despite normal C-reactive protein level and leukocyte counts.
Persistently elevated serum PCT level might occur in conditions without evidence of sepsis. Taking consideration of multiple inflammatory factors to determine infection when the markedly elevated PCT level was not correlated with the clinical manifestations.
血清降钙素原（PCT）升高一直被视为全身性细菌感染和脓毒症的标志物。然而，在非脓毒症情况下PCT显著升高的情况较为罕见。在此，我们报告一例罕见病例，一名患有结核病的透析患者血清PCT持续显著升高，但无脓毒症证据。
一名25岁维持性血液透析患者因肾移植入院。入院时体格检查发现双侧颈部可触及多个淋巴结，后来活检病理证实为结核病。入院后第3天，患者发热，体温38.8°C。白细胞计数为12.35×10/L，PCT水平为5.73 ng/mL。随后PCT升至63.10 ng/mL，C反应蛋白水平为186.00 mg/L。抗生素从头孢美唑升级为美罗培南并加用万古霉素后，体温在第17天降至正常范围且此后一直正常。PCT水平在第21天逐渐降至4.18 ng/mL，并开始抗结核治疗。此后，PCT水平在2.9 ng/mL至94.9 ng/mL之间波动，无任何脓毒症表现。尽管C反应蛋白水平和白细胞计数正常，但血清PCT水平仍持续显著升高。
在无脓毒症证据的情况下可能出现血清PCT水平持续升高。当PCT水平显著升高与临床表现不相关时，应综合考虑多种炎症因素以确定感染情况。
