Yu Dongxu, Shi Leilei, Zhang Xinrui, Yang Huifen, Feng Jing, Wang Yubao
Department of Infectious Diseases, Second Hospital of Tianjin Medical University, Tianjin, China; Respiratory Department, Tianjin Medical University General Hospital, Tianjin, China.
Department of Hypertension, TEDA International Cardiovascular Hospital, Tianjin, China.
Int J Infect Dis. 2023 May;130:144-146. doi: 10.1016/j.ijid.2023.02.027. Epub 2023 Mar 9.
We reported a case of a 68-year-old man who presented with recurrent fever and multiorgan dysfunction. His significantly elevated procalcitonin and C-reactive protein levels indicated recurrent sepsis. However, no focus of infection and no pathogens were identified through a variety of examinations and tests. Although the increase of creatine kinase was less than five times the upper limit of normal value, the diagnosis of rhabdomyolysis secondary to adrenal insufficiency resulting from primary empty sella syndrome was finally made, as supported by serum myoglobin elevation, serum cortisol, and adrenocorticotropic hormone deficiency, bilateral adrenal atrophy on computed tomography, and empty sella on magnetic resonance imaging. After the glucocorticoid replacement treatment, the patient's myoglobin gradually returned to normal range, and his condition continued to improve. Rhabdomyolysis resulting from a rare cause may be misdiagnosed as sepsis in patients who present with increased procalcitonin levels.
我们报告了一例68岁男性，其表现为反复发热和多器官功能障碍。他的降钙素原和C反应蛋白水平显著升高，提示反复发生败血症。然而，通过各种检查和检测未发现感染灶及病原体。尽管肌酸激酶升高幅度小于正常上限的五倍，但最终诊断为原发性空蝶鞍综合征导致肾上腺功能不全继发横纹肌溶解，血清肌红蛋白升高、血清皮质醇和促肾上腺皮质激素缺乏、计算机断层扫描显示双侧肾上腺萎缩以及磁共振成像显示空蝶鞍均支持这一诊断。糖皮质激素替代治疗后，患者的肌红蛋白逐渐恢复至正常范围，病情持续改善。在降钙素原水平升高的患者中，由罕见原因引起的横纹肌溶解可能被误诊为败血症。
