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Research Letter |

High Procalcitonin Levels in Patients With Severe Drug Reactions FREE

Mehdi Sfia, MD; Peggy Boeckler, MD; Dan Lipsker, MD, PhD
Arch Dermatol. 2007;143(12):1589-1603. doi:10.1001/archderm.143.12.1591-a.
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Published online

Although procalcitonin (PCT) serum level is still considered to be a highly specific and sensitive biologic marker of severe bacterial infections, it can be increased in noninfectious situations such as diffuse metastatic solid cancers,1 C-cell carcinoma of the thyroid gland,2 major trauma or surgery,3,4 or after cardiopulmonary bypass.5 Herein we show that PCT level increases in some patients with severe drug reactions. Clinicians should therefore not rely on PCT values to discriminate between infectious and immunoallergic eruptions in patients who present with fever and a rash.

We investigated 8 consecutive patients with a severe cutaneous drug eruption. Four patients had Stevens-Johnson syndrome (SJS); 2 had drug rash, eosinophilia, and systemic symptoms syndrome (DRESS); 1 had acute generalized exanthematous pustulosis; and 1 had Lyell syndrome. The diagnosis of drug eruption was based on clinical, biologic, and histologic findings. In all cases, investigations including routine biology tests, blood cultures, urinary bacterial examination, pulmonary radiography, and serology failed to identify any bacterial or viral agent.

Procalcitonin levels were significantly elevated in 2 patients, one with DRESS (3.96 μg/L) and the other with SJS (0.53 μg/L). All patients healed within a mean of 25 days (range, 15-45 days) without any antibiotic treatment.

Our findings suggest that in some patients with severe drug eruptions, PCT level can be elevated in the absence of bacterial infection. Thus, elevated PCT levels neither predict infection in patients with severe drug rashes nor allow discrimination between infectious and noninfectious eruptions.

ARTICLE INFORMATION

Correspondence: Dr Lipsker, Clinique Dermatologique, Hopitaux Universitaites, 1 Place de l’Hopital, 67091 Strasbourg CEDEX, France (dan.lipsker@gmail.com).

Financial Disclosure: None reported.

Matzaraki  VAlexandraki  KIVenetsanou  K  et al.  Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem 2007;40 (5-6) 336- 342
PubMed Link to Article
Bertagna  XYNicholson  WEPettengill  OSSorenson  GDMount  CDOrth  DN Ectopic production of high molecular weight calcitonin and corticotropin by human small cell carcinoma cells in tissue culture: evidence for separate precursors. J Clin Endocrinol Metab 1978;47 (6) 1390- 1393
PubMed Link to Article
Meisner  MTschaikowsky  KHutzler  ASchick  CSchuttler  J Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998;24 (7) 680- 684
PubMed Link to Article
Mimoz  OBenoist  JFEdouard  ARAssicot  MBohuon  CSamii  K Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med 1998;24 (2) 185- 188
PubMed Link to Article
Meisner  MTschaikowsky  KSchmidt  JSchüttler  J Procalcitonin (PCT)—indications for a new diagnostic parameter of severe bacterial infection and sepsis in transplantation, immunosuppression, and cardiac assist devices. Cardiovasc Eng 1996;1 (1) 67- 76

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References

Matzaraki  VAlexandraki  KIVenetsanou  K  et al.  Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem 2007;40 (5-6) 336- 342
PubMed Link to Article
Bertagna  XYNicholson  WEPettengill  OSSorenson  GDMount  CDOrth  DN Ectopic production of high molecular weight calcitonin and corticotropin by human small cell carcinoma cells in tissue culture: evidence for separate precursors. J Clin Endocrinol Metab 1978;47 (6) 1390- 1393
PubMed Link to Article
Meisner  MTschaikowsky  KHutzler  ASchick  CSchuttler  J Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998;24 (7) 680- 684
PubMed Link to Article
Mimoz  OBenoist  JFEdouard  ARAssicot  MBohuon  CSamii  K Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med 1998;24 (2) 185- 188
PubMed Link to Article
Meisner  MTschaikowsky  KSchmidt  JSchüttler  J Procalcitonin (PCT)—indications for a new diagnostic parameter of severe bacterial infection and sepsis in transplantation, immunosuppression, and cardiac assist devices. Cardiovasc Eng 1996;1 (1) 67- 76

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