A Pancreatic Neuroendocrine carcinoma with Super High Procalcitonin mimicking Sepsis Shock: case report and literature review

Abstract Besides medullary thyroid cancer, a latent and relatively mild increase of serum procalcitonin (PCT) has been found in neuroendocrine neoplasms (NENs). Here we are aiming to supply more information about NENs related PCT elevation, in order to broaden the clinical experiences about diagnosis and treatment of shock in tumor patients. we reported an advanced pancreatic neuroendocrine carcinoma (pNEC) with liver and lung metastasis, in which a rare pseudo-sepsis shock with extremely high serum PCT level (exceeding 100 ng/ml) had been demonstrated. A series of screening tests to exclude bacterial infections, including blood culture, urine culture and even metagenomic NGS (mNGS), had been performed. Given negative evidence of bacterial infection and useless broad-spectrum antibiotics treatment, steroid was used to relieve the serious inflammation and its related shock. The patient’s condition was improved and discharged. In summary, despite the ubiquitous use of PCT used in bacterial infection and sepsis shock, pNEC could cause the high level of serum PCT and even result in severe inflammation accompanied by shock. As for diagnosis and treatment strategies, pNEC should be regarded as one of rare differential diagnosis when experimental antibiotics are not working. The potential mechanism of PCT elevation and its role in prognosis of pNEC still needed to be further studied.