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Artificial Sepsis: Think Twice Before Pausing Therapy

  • Annie Mathew
    Affiliations
    Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Germany
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  • Dagmar Führer
    Affiliations
    Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Germany
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  • Harald Lahner
    Correspondence
    Requests for reprints should be addressed to Harald Lahner, MD, Head, ENETS Center of Excellence, Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumor Center at WTZ/Comprehensive Cancer Center, University Hospital Essen, Hufelandstr 55, 45122 Essen.
    Affiliations
    Department of Endocrinology, Diabetes and Metabolism and Division of Laboratory Research, Endocrine Tumor Center at WTZ/ Comprehensive Cancer Center and ENETS Center of Excellence, University Hospital Essen, University of Duisburg-Essen, Germany
    Search for articles by this author
Published:October 27, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.10.006
      We describe the case of a 58-year-old female patient presenting with a differentiated neuroendocrine tumor of the pancreas and hepatic metastases that was initially diagnosed in September of 2020. In October of 2020, chemotherapy with streptozocin and 5-fluorouracil was started. At the request of the patient, a port was implanted before starting the second chemotherapy cycle. Postinterventional routine laboratory testing showed increased C-reactive protein levels of 1.6 mg/dL (reference range: <0.5 mg/dL) and highly elevated procalcitonin levels of 15.4 ng/mL (reference range: 0-0.5 ng/mL), suggesting that chemotherapy should be paused and the infection treated. However, no symptoms of systemic inflammation were evident. Puzzled by these discrepant findings, paraneoplastic production of calcitonin was suspected. Further laboratory testing showed highly elevated calcitonin levels of 10,684 pg/mL (reference range: <5 pg/mL) in the absence of thyroid disease. This finding confirmed that the increase in sepsis markers was not correlated with an inflammatory process but with paraneoplastic endocrine syndrome in a patient with cancer. Therefore, chemotherapy was applied according to the regimen without any delay. Thus, the alarming sepsis markers had no therapeutic consequence. The patient showed stable disease after 3 cycles of chemotherapy with calcitonin levels continuously dropping to 1,410 pg/mL immediately after the sixth chemotherapy cycle in July of 2021 (Figure), indicating a reduction in tumor mass and treatment response.
      Figure
      FigureProcalcitonin and calcitonin levels during the second to sixth cycle of streptozocin-based chemotherapy (arrows).
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      References

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