Intensive care management of a rare case of pyrexia of unknown origin (Kikuchi-Fujimoto disease).

Kikuchi-Fujimoto disease is a rare, benign cause of necrotising lymphadenitis often presenting with fever. We describe a case of a 17-year-old boy with non-verbal autism presenting to our intensive care unit with prolonged fever of unknown cause. This case highlights the role of the intensive care unit in cases of diagnostic dilemma. The critical care community should be aware of Kikuchi-Fujimoto disease as although it is usually benign, it can rarely lead to acute airway compromise.

Prospective evaluation of procalcitonin in sepsis in the Illawarra area of Australia: PEPSIA study.

INTRODUCTION: Procalcitonin (PCT) is a precursor of the hormone calcitonin and has been proposed as a marker of infection in critically ill patients. We evaluated the role of procalcitonin in the early detection of sepsis in an Australian intensive care-high dependency unit (ICU/HDU). METHODS: This prospective observational study enrolled 204 consecutive patients admitted to the ICU/HDU of Wollongong Hospital, NSW, over a 3-month period, October to December 2001. Of the 204, 172 (84%) were included in the final analysis. Patient demographic data, serum PCT levels and the vital signs required to score the criteria for systemic inflammatory response syndrome (SIRS) and sepsis were recorded daily until the patient left the ICU. Cultures were obtained when clinically indicated. RESULTS: PCT measurement appears a useful screening test for sepsis with a cut-off value > 0.85 ng/dL. At levels >10 ng/dL, its diagnostic accuracy improves significantly. PCT level was able to discriminate between sepsis and nonsepsis, and between septic shock and non-septic shock. However, it failed to discriminate well between bacterial and non-bacterial SIRS with a 95% CI for area under the receiver operating characteristic curve of 0.59-0.76. CONCLUSIONS: The use of PCT as a screening test (PCT >0.85ng/dL) in conjunction with traditional criteria is of value in the early diagnosis of bacterial sepsis in suspected cases in the ICU. PCT appears to be a reliable diagnostic test for bacterial sepsis at levels > 10 ng/dL.