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.

Activated protein C in toxic shock syndrome: a case report

The mortality from septic shock remains high despite the availability of modern critical care facilities. In recent years, new agents have been tested to reduce morbidity and mortality in patients with severe sepsis. Among them, recombinant human activated protein C (rhAPC) has been reported to significantly reduce mortality and morbidity in patients with severe sepsis and one or more acute organ failures. We describe our experience with this drug in the early reversal of septic shock from toxic shock syndrome.

An intermittent foreign body in the airway: a case report

A case is described of a surgical 'stay' suture which apparently disappeared from the tracheostomy site and took an unusual course before it reappeared in the patient's tracheostomy tube. Our report highlights the importance of documentation of the surgical techniques and procedures used in the performance of a tracheostomy and the importance of daily bedside examinations in the critically ill patient.

Conservative management of a posterior tracheal tear: a case report

We describe a case of posterior tracheal wall tear managed conservatively with a successful outcome. The presentation of a sudden increase in cuff volume and subcutaneous emphysema presents a challenging management problem requiring careful bronchoscopic and computed tomography delineation and isolation of the injury using a double lumen tube. This case also highlights the vulnerability of the trachea to injury from airway intervention and considers the possible mechanisms of tracheal injuries during the commonly performed intensive care procedure of percutaneous tracheostomy.