Advertisement

Clinical Rheumatology

, Volume 26, Issue 12, pp 2059–2062 | Cite as

Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

  • Bunyamin Kisacik
  • Umut Kalyoncu
  • M. Fatih Erol
  • Omer Karadag
  • Mustafa Yildiz
  • Ali Akdogan
  • Bugra Kaptanoglu
  • Mutlu Hayran
  • Kemal Ureten
  • Ihsan Ertenli
  • Sedat Kiraz
  • Meral Calguneri
Original Article

Abstract

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 ± 8.1 years (range 2–33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 ± 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 ± 0.96] vs 0.095 [0.01–0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

Keywords

Acute abdominal attack Acute phase reactant Appendicitis Familial Mediterranean fever Procalcitonin 

Notes

Acknowledgement

We thank the Society for Research and Education in Rheumatology for the financial support of the study.

References

  1. 1.
    Althausen TL, Deamer WC, Ker WJ (1937) The false “acute abdomen”. II. Henoch’s purpura and abdominal allergy. Ann Surg 106:242–251CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Simon A, van der Meer JW, Drenth JP (2005) Familial Mediterranean fever—a not so unusual cause of abdominal pain. Best Pract Res Clin Gastroenterol 19:199–213CrossRefPubMedGoogle Scholar
  3. 3.
    Reissman P, Durst AL, Rivkind A, Szold A, Ben-Chetrit E (1994) Elective laparoscopic appendectomy in patients with familial Mediterranean fever. World J Surg 18:139–141CrossRefPubMedGoogle Scholar
  4. 4.
    Gendrel D, Bohuon C (2000) Procalcitonin as a marker of bacterial infection. Pediatr Infect Dis J 19:679–687CrossRefPubMedGoogle Scholar
  5. 5.
    Kafetzis DA, Velissariou IM, Nikolaides P, Sklavos M, Maktabi M, Spyridis G, Kafetzis DD, Androulakakis E (2005) Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis 24:484–487CrossRefPubMedGoogle Scholar
  6. 6.
    Bennion RS, Thompson JE Jr, Baron EJ, Finegold SM (1990) Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther 12(Suppl C):31–44PubMedGoogle Scholar
  7. 7.
    Baron EJ, Bennion RS, Thompson JE Jr, Strong C, Summanen P, McTeague M (1992) A microbiological comparison between acute and complicated appendicitis. Clin Infect Dis 14:227–231CrossRefPubMedGoogle Scholar
  8. 8.
    Sohar E, Gafni J, Pras M, Heller H (1967) Familial Mediterranean fever. A survey of 470 cases and review of the literature. Am J Med 43(2):227–253CrossRefPubMedGoogle Scholar
  9. 9.
    Hallan S, Asberg A (1997) The accuracy of C-reactive protein in diagnosing acute appendicitis—a meta-analysis. Scand J Clin Lab Invest 57(5):373–380CrossRefPubMedGoogle Scholar
  10. 10.
    Prystowsky JB, Pugh CM, Nagle AP (2005) Current problems in surgery. Appendicitis. Curr Probl Surg 42:688–742CrossRefPubMedGoogle Scholar
  11. 11.
    Tunca M, Akar S, Onen F, Ozdogan H, Kasapcopur O, Yalcinkaya F, Tutar E, Ozen S, Topaloglu R, Yilmaz E, Arici M, Bakkaloglu A, Besbas N, Akpolat T, Dinc A, Erken E, Turkish FMF Study Group (2005) Familial Mediterranean fever (FMF) in Turkey: results of a nationwide multicenter study. Medicine (Baltimore) 84(1):1–11CrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2007

Authors and Affiliations

  • Bunyamin Kisacik
    • 1
    • 5
  • Umut Kalyoncu
    • 1
  • M. Fatih Erol
    • 2
  • Omer Karadag
    • 1
  • Mustafa Yildiz
    • 2
  • Ali Akdogan
    • 1
  • Bugra Kaptanoglu
    • 2
  • Mutlu Hayran
    • 3
  • Kemal Ureten
    • 4
  • Ihsan Ertenli
    • 1
  • Sedat Kiraz
    • 1
  • Meral Calguneri
    • 1
  1. 1.Division of Rheumatology, Department of Internal Medicine, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  2. 2.4th Surgery Clinic, Ankara Education and Research HospitalMinistry of HealthAnkaraTurkey
  3. 3.Department of Preventive Oncology, Faculty of MedicineHacettepe UniversityAnkaraTurkey
  4. 4.Rheumatology Clinic, Ankara Education and Research HospitalMinistry of HealthAnkaraTurkey
  5. 5.Hacettepe Universitesi Tip Fakultesi Romatoloji UnitesiSihhiye, AnkaraTurkey

Personalised recommendations