Trevor Van Schooneveld, Internal Medicine, Infectious Disease
65-year-old female from long-term care facility
Increasing shortness of breath over the last day with minimally productive cough
Cough, cyanotic, no fevers/chills, oxygen saturation at facility in 80s
Significant medical history:
Recently discharged from hospital for acute myocardial infarction after stenting.
White blood count 12.6 x 103/µL (87% neutrophils), lactate 2.9 mmol/L, mild acute kidney injury (AKI), PCT = < 0.05 μg/L
Community acquired pneumonia with sepsis vs. Atrial fibrillation (AFib) with rapid ventricular response and heart failure
Dose of antibiotics given in ED but not continued by hospitalist team. Diuretics provided and AFib rate controlled with beta-blocker. Significantly improved in the morning.
This patient had a diagnosis of heart failure secondary to acute myocardial infarction (AMI) two days prior, but the clinical presentation offered multiple possibilities of differential diagnoses. PCT gives insight into the presence or absence of systemic bacterial infection. In this case, PCT supported the absence of bacterial infection, and it was not necessary to start antibiotics. Clinicians were able to focus on treating the cardiac issues at hand.
Submit your own PCT Case Study and you may be selected to be featured on procalcitonin.com. First 5 submissions receive a copy of Procalcitonin – Biochemistry and Clinical Diagnosis by Michael Meisner. This book overviews the most important areas of PCT application.