Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.
Blood Purif. 2011;32(2):139-42. doi: 10.1159/000325731. Epub 2011 Jun 7.
This case report describes polymyxin B-immobilized fiber (PMX-F) treatment of septic shock caused by pyelonephritis in a 68-year-old woman with autosomal dominant polycystic kidney disease. She was admitted for severe lower left abdominal pain, high fever (40°C) and gross hematuria. Her endotoxin and high-mobility group box-1 protein (HMGB1) levels were extremely elevated. Her blood pressure was 68/36 mm Hg. Urinalysis revealed innumerable white blood cells (WBCs). Blood and urine cultures were positive for Klebsiella pneumoniae and Pseudomonas aeruginosa. Plain abdominal radiography showed large kidney shadows and calcium deposition. Septic shock with endotoxemia was diagnosed. Her symptoms of septic shock persisted for 3 days with antibiotics, γ-globulin and dopamine. Direct hemoperfusion was performed twice with a PMX-F column. The patient's body temperature, WBC count and C-reactive protein level decreased. Her blood endotoxin level and blood HMGB1 level also decreased to an almost normal level. She was discharged on day 23 after admission.
本病例报告描述了 1 例多囊肾病 68 岁女性，因肾盂肾炎引起的感染性休克，使用多粘菌素 B 固定纤维（PMX-F）治疗。患者因严重左下腹痛、高热（40°C）和肉眼血尿入院。其内毒素和高迁移率族蛋白 1（HMGB1）水平显著升高。血压为 68/36mmHg。尿分析显示无数白细胞（WBC）。血和尿培养均为肺炎克雷伯菌和铜绿假单胞菌阳性。腹部平片显示大的肾脏阴影和钙沉积。诊断为伴有内毒素血症的感染性休克。患者在抗生素、γ-球蛋白和多巴胺治疗下，感染性休克症状持续了 3 天。两次使用 PMX-F 柱进行直接血液灌流。患者体温、白细胞计数和 C 反应蛋白水平下降。血内毒素和血 HMGB1 水平也降至接近正常水平。入院后第 23 天患者出院。
