Journal of Yeungnam Medical Science

Case report

Interleukin-6-producing paraganglioma as a rare cause of systemic inflammatory response syndrome: a case report: Yin Young Lee, Seung Min Chung; J Yeungnam Med Sci. 2023;40(4):435-441. Published online March 7, 2023; DOI: https://doi.org/10.12701/jyms.2022.00766

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Abstract PDF: Pheochromocytomas and paragangliomas (PPGLs) may secrete hormones or bioactive neuropeptides such as interleukin-6 (IL-6), which can mask the clinical manifestations of catecholamine hypersecretion. We report the case of a patient with delayed diagnosis of paraganglioma due to the development of IL-6-mediated systemic inflammatory response syndrome (SIRS). A 58-year-old woman presented with dyspnea and flank pain accompanied by SIRS and acute cardiac, kidney, and liver injuries. A left paravertebral mass was incidentally observed on abdominal computed tomography (CT). Biochemical tests revealed increased 24-hour urinary metanephrine (2.12 mg/day), plasma norepinephrine (1,588 pg/mL), plasma normetanephrine (2.27 nmol/L), and IL-6 (16.5 pg/mL) levels. 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT showed increased uptake of FDG in the left paravertebral mass without metastases. The patient was finally diagnosed with functional paraganglioma crisis. The precipitating factor was unclear, but phendimetrazine tartrate, a norepinephrine-dopamine release drug that the patient regularly took, might have stimulated the paraganglioma. The patient’s body temperature and blood pressure were well controlled after alpha-blocker administration, and the retroperitoneal mass was surgically resected successfully. After surgery, the patient’s inflammatory, cardiac, renal, and hepatic biomarkers and catecholamine levels improved. In conclusion, our report emphasizes the importance of IL-6-producing PPGLs in the differential diagnosis of SIRS.

Original Article

Clinical Significance of Interleukin-6 Concentration of Cervical Discharge in Pregnant Women with Preterm Labor and Preterm Rupture of Membrane: Seong Woong Kim, Sung Chul Park, Sung Ho Lee, Doo Jin Lee; Yeungnam Univ J Med. 2007;24(2 Suppl):S505-518. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S505

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Abstract PDF: Background
：This study is conducted to determine the clinical efficacy of measurement of IL-6 concentration in cervical discharge as a biochemical predictor of preterm labor and PROM. Materials and Methods：Twenty-two pregnant women with preterm labor and 28 women with preterm rupture of membrane(PROM) between 20-36 gestational weeks were selected as study group, and 26 normal pregnant women were selected as control group. In both groups, following routine antenatal laboratory tests, concentration of interleukin-6(IL-6) in cervical discharge and amniotic fluid(in case of preterm labor and PROM) were estimated, and maternal C-reactive protein(CRP) level and WBC count were checked also. To compare the microbiological environment of both groups, Gram stain and culture of cervical smear were undertaken.
Results
：There were no significant differences in maternal age, gravity, parity, gestational age at sampling, and prior preterm delivery, but there were significant differences in initial cervical dilation, effacement, cervicovaginal pH, and preterm delivery in each groups. The average IL-6 level of cervical discharge in women with preterm labor and PROM were significantly higher than control group (p＜0.01). The distribution of women with preterm labor and PROM were significantly different from control group, when 186.7 pg/mL was selected as cutoff value(p＜0.01). There was strong positive correlation between IL-6 concentration in cervical discharge and amniotic fluid IL-6 concentration (r=0.865, p＜0.05). There was no significant difference in CRP in each groups. Maternal WBC count of PROM group at admission was higher than that of preterm labor and control group, but was not statistically significant (p=0.062). Gram (-) rods was detected frequently in women with preterm labor and PROM than control group (p＜0.05). The distribution of microorganisms in cervical discharge in women with preterm labor and PROM were different from control group. Conlusion：The results of this study suggested that cervical IL-6 concentration could be used as an indicator detecting the high risk pregnant women who might develop preterm labor and PROM, and could be accepted as a noninvasive diagnostic marker of intrauterine infection.

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