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内脏皮肤型棕蛛咬伤所致多器官功能衰竭中的血液吸附

Hemoadsorption in Multiorgan Failure Due to Viscerocutaneous Loxoscelism.

作者信息

Valenzuela Córdova Raúl, Rivera Estrella David, Bernardo José F, Jiménez Darío, Rodríguez Tudero Celia, Elías Raúl, De La Flor José C

机构信息

Department of Nephrology, Hospital Nacional Cayetano Heredia, Lima 15002, Peru.

Faculty of Medicine, Peruana Cayetano Heredia University, Lima 15002, Peru.

出版信息

Medicina (Kaunas). 2025 Jan 16;61(1):143. doi: 10.3390/medicina61010143.

Abstract

: The bite of the Loxosceles spider is a public health problem around the world, mainly in Latin America. The viscerocutaneous presentation is related to the inoculation of toxins (phospholipase-D) that generates a systemic inflammatory reaction with a subsequent increase in cytokines and chemokines. Hemoadsorption is proposed as a therapy that allows for the removal of the toxin and modulation of the inflammatory response in this disease. : We present the case of a 31-year-old woman who was admitted to the hospital due to decreased urinary flow and jaundice 48 h after a spider bite. Despite treatment with intravenous (IV) monovalent antiloxoscelism serum, antibiotic therapy, and corticosteroids, the patient's evolution was poor, and she was admitted to the critical care unit for severe multi-organ involvement, including hepatic and kidney damage and coagulation disorders, eventually requiring hemodialysis support and hemoadsorption therapy. After the therapy was administered, rapid improvement was evident with the suspension of vasopressor support and a decrease in inflammatory markers. : This case presents hemoadsorption as a therapeutic option, based on its capacity to reduce the intensity of hyperinflammation and to regulate the immunological response.

摘要

巴西游走蛛的叮咬是一个全球性的公共卫生问题,主要发生在拉丁美洲。皮肤内脏型表现与毒素(磷脂酶-D)的注入有关,毒素会引发全身炎症反应,随后细胞因子和趋化因子增加。血液吸附被提议作为一种治疗方法,可用于清除毒素并调节该疾病中的炎症反应。

我们报告一例31岁女性病例,该患者在蜘蛛叮咬48小时后因尿量减少和黄疸入院。尽管接受了静脉注射单价抗巴西游走蛛毒血清、抗生素治疗和皮质类固醇治疗,但患者病情进展不佳,因严重多器官受累(包括肝、肾损害和凝血障碍)被收入重症监护病房,最终需要血液透析支持和血液吸附治疗。治疗后,血管升压药支持停止,炎症标志物下降,病情明显迅速改善。

该病例表明,基于血液吸附降低过度炎症强度和调节免疫反应的能力,它可作为一种治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/143c/11766656/8b1312ad8c97/medicina-61-00143-g001.jpg

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