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Intravenous Endotoxin Challenge in Healthy Humans: An Experimental Platform to Investigate and Modulate Systemic Inflammation
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Endotoxin shock due to Vibrio vulnificus infection

Takaharu Ikeda1, Shoko Kanehara, Toshio Ohtani

  • 1Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan. t-ikeda@wakayama-med.ac.jp

European Journal of Dermatology : EJD
|August 29, 2006
PubMed

Insights

A patient with hepatitis C developed Vibrio vulnificus septic shock after eating undercooked fish. Combined therapy including Polymyxin B hemoperfusion and IVIg reversed shock and lowered IL-6 levels.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Dermatology

Background:

  • Hepatitis C infection can predispose individuals to severe bacterial infections.
  • Undercooked seafood is a known source of Vibrio vulnificus.
  • Septic shock presents a critical medical emergency requiring prompt intervention.

Observation:

  • A 54-year-old man with hepatitis C presented with shock and enterocolitis-like symptoms after consuming undercooked mackerel.
  • Skin eruptions evolved into annular erythema with vesicles.
  • Initial treatment with corticosteroids and cefotiam did not prevent shock exacerbation.

Findings:

  • Vibrio vulnificus septic shock was diagnosed via skin biopsy culture.
  • Combined therapy with piperacillin, intravenous immunoglobulin (IVIg), and Polymyxin B immobilized fiber (PMX-F) hemoperfusion led to shock reversal.
  • Significant reduction in serum Interleukin-6 (IL-6) levels was observed, correlating with treatment efficacy.

Implications:

  • Hemoperfusion with PMX-F and IVIg is a potentially effective treatment strategy for severe Vibrio vulnificus septic shock.
  • This case suggests that debridement may not always be necessary in Vibrio vulnificus sepsis.
  • Monitoring IL-6 levels can be useful in assessing treatment response in septic shock.

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