E12. C-REACTIVE PROTEIN OF UNKNOWN ORIGIN

Management of fever in prolonged profound neutropenia remains challenging with many possible infectious and non-infectious causes. We investigated whether procalcitonin (PCT) is superior to C-reactive protein (CRP) in discriminating between different etiologies of fever in this setting. CRP and PCT were tested daily during 93 neutropenic episodes in 66 patients. During this study period 121 febrile episodes occurred and were classified into four categories based on clinical and microbiological findings: microbiologically documented infection (MDI); clinically documented infection (CDI); proven or probable invasive fungal disease (IFD); fever of unknown origin (FUO). Values of PCT and CRP at fever onset as well as 2 days later were considered for analysis of their performance in distinguishing etiologies of fever. At fever onset no significant difference in PCT values was observed between different etiologies of fever, whereas median CRP values were significantly higher in case of IFD (median 98.8 mg/L vs 28.8 mg/L, p=0.027). Both PCT and CRP reached their peak at a median of 2 days after fever onset. Median PCT values on day 2 showed no significant difference between etiologies of fever. Median CRP values on day 2 were significantly higher in IFD (median 172 mg/L versus 78.4 mg/L, p=0.002). In MDI median CRP values rose > 100 mg/L, whereas they did not in CDI or FUO. PCT has no added value over CRP for clinical management of fever in prolonged profound neutropenia. When performing reassessment 2 days after fever onset, CRP has better discriminatory power between etiologies of fever.

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18F-FDG-PET/CT in unexplained elevated inflammatory markers

Nuklearmedizin ◽

10.3413/nukmed-0798-16-02 ◽

2016 ◽

Vol 55 (06) ◽

pp. 242-249 ◽

Cited By ~ 1

Author(s):

Isabell Braune ◽

Birgit Meller ◽

Carsten Sahlmann ◽

Carsten Ritter ◽

Johannes Meller ◽

...

Keyword(s):

Fdg Pet ◽

Unknown Origin ◽

Final Diagnosis ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

SummaryThe diagnostic strategy in patients with fever or inflammation of unknown origin remains a major clinical challenge. The aim of this study was to evaluate the role of 18F-FDG-PET/CT in patients with unexplained elevated C-reactive protein with or without fever. Contribution of 18F-FDG-PET/CT to the final diagnosis was evaluated. In addition we determined whether a differentiation between patients with or without fever is clinically reasonable. Patients, methods: We retrospectively analysed 72 consecutive patients with unexplained elevated C-reactive protein levels (above 8mg/l) that underwent 18F-FDG-PET/ CT in our facility between 10/2009 and 11/2012. 18F-FDG-PET/CT was considered a so-called diagnostic scan when results decisively led to a final diagnosis and adequate therapy with a response of symptoms was initiated due to the PET/CT result. Results: In 60/72 patients (83%) a final diagnosis was established. Diagnoses included infections (58%), non-infectious inflammatory diseases (29%) and malignancies (8%). 18F-FDG-PET/CT was true positive in 47 cases (65%) and the diagnostic scan in 29 patients (40%). Sensitivity of 18F-FDG-PET/CT was 81% and specificity was 86%. Diagnostics, final diagnoses, 18F-FDG-PET/CT results, SUVmax, C-reactive protein levels and the diagnostic scan did not differ significantly between patients with fever and patients without fever. Conclusion: 18F-FDG-PET/CT is a useful method in the diagnostic workup of patients with inflammation of unknown origin. In our series there was no significant difference between patients with or without fever. Regarding 18F-FDG-PET/CT-imaging inflammation of unknown origin and unexplained fever can be joined to one entity.

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Activities of dipeptidyl peptidase II and dipeptidyl peptidase IV in synovial fluid from patients with rheumatoid arthritis and osteoarthritis.

Clinical Chemistry ◽

10.1093/clinchem/35.6.1016 ◽

1989 ◽

Vol 35 (6) ◽

pp. 1016-1018 ◽

Cited By ~ 36

Author(s):

H Gotoh ◽

M Hagihara ◽

T Nagatsu ◽

H Iwata ◽

T Miura

Keyword(s):

Rheumatoid Arthritis ◽

Synovial Fluid ◽

Unknown Origin ◽

Dipeptidyl Peptidase ◽

Dipeptidyl Peptidase Iv ◽

Joint Effusion ◽

C Reactive Protein ◽

Reactive Protein ◽

Dpp Iv ◽

Protein Reaction

Abstract We examined the activities of peptidases in synovial fluid from patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Dipeptidyl peptidase IV (DPP IV) activity was lower in synovial fluid from patients with RA, in contrast to the increase of DPP II activity in synovial fluid, as compared with OA. The DPP II/DPP IV ratio for synovial fluid was significantly higher in patients with RA than in patients with OA. A significant correlation was observed between the DPP II/DPP IV ratio for synovial fluid from patients with RA and the amount of C-reactive protein reaction. These results may be useful in the diagnosis of joint effusion of unknown origin.

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The predictive value of C-reactive protein and erythrocyte sedimentation rate for 18F-FDG PET/CT outcome in patients with fever and inflammation of unknown origin

Nuclear Medicine Communications ◽

10.1097/mnm.0000000000000300 ◽

2015 ◽

Vol 36 (6) ◽

pp. 604-609 ◽

Cited By ~ 12

Author(s):

Hans Balink ◽

Nic J.G.M. Veeger ◽

Roel J. Bennink ◽

Riemer H.J.A. Slart ◽

Frits Holleman ◽

...

Keyword(s):

Sedimentation Rate ◽

Predictive Value ◽

Fdg Pet ◽

Unknown Origin ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Clear cell meningioma causing Castleman syndrome in a child

Journal of Neurosurgery Pediatrics ◽

10.3171/2010.1.peds09413 ◽

2010 ◽

Vol 5 (6) ◽

pp. 622-625 ◽

Cited By ~ 11

Author(s):

Takashi Sato ◽

Takeshi Sugiyama ◽

Tomoyuki Kawataki ◽

Eiji Sato ◽

Toru Horikoshi ◽

...

Keyword(s):

Fever Of Unknown Origin ◽

Gamma Globulin ◽

Clear Cell ◽

Unknown Origin ◽

Surgical Removal ◽

C Reactive Protein ◽

Presumptive Diagnosis ◽

Reactive Protein ◽

Clear Cell Meningioma ◽

Biochemical Abnormalities

This 11-year-old boy presented with a rare case of Castleman syndrome caused by a clear cell meningioma manifesting as persistent fever of unknown origin, 2 years after glomerulonephritis. Laboratory investigation of the patient showed an increased inflammatory reaction, as well as elevated polyclonal gamma globulin titer and serum level of C-reactive protein. Magnetic resonance imaging revealed a tumor at the cerebellopontine angle. Neurosurgical intervention was performed under the presumptive diagnosis of Castleman syndrome caused by intracranial tumor. Histological examination of the tumor verified that it was clear cell meningioma with infiltration of lymphoplasma cells, and surgical removal resulted in complete resolution of the patient's symptoms and biochemical abnormalities. The present case of clear cell meningioma manifesting as Castleman syndrome shows that the possibility of a brain tumor should be considered in patients presenting with fever of unknown origin, anemia, hypergammaglobulinemia, or other systemic illness.

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