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Beneficial effects of PMX-DHP on vasopressor-resistant invasive meningococcal disease: a case report
Yuki Hattori1, Nobutaka Chiba1, Shingo Ihara1
1Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan.
Introduction And Importance:
The efficacy of polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) for controlling inflammatory cytokines in patients with invasive meningococcal disease, which causes excessive release of inflammatory cytokines due to massive amounts of bacterial endotoxins, remains unclear.
Case Presentation:
A 39-year-old male with invasive meningococcal disease, characterized by a blood endotoxin concentration ≥2000 pg/mL, developed circulatory failure unresponsive to vasopressors, respiratory failure, renal failure, and coagulation abnormalities. Three hours after admission, PMX-DHP was performed for 18 hours of treatment. Following the procedure, a reduction in the use of vasopressors became possible due to improved hemodynamics. Simultaneously, decreases in cytokine concentrations were observed.
Clinical Discussion:
Although immunomodulatory therapy may improve the excessive inflammatory state in the early stages of sepsis, it may impair infection control and worsen outcomes during the later stages of immunodeficiency, making early initiation and prolonged use of PMX-DHP ideal.
Conclusions:
In a patient with invasive meningococcal disease complicated by septic shock, PMX-DHP was administered for a total of 18 hours, resulting in reductions in blood cytokine levels and dosages of vasopressors for rapidly progressing and vasopressor-resistant circulatory failure.
Insights
Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) effectively reduced inflammatory cytokines and vasopressor dependence in a patient with severe invasive meningococcal disease and septic shock. Early and prolonged PMX-DHP may be beneficial.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Nephrology
Background:
- Invasive meningococcal disease can cause excessive inflammatory cytokine release due to bacterial endotoxins, leading to severe complications like septic shock.
- The efficacy of polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) in managing these inflammatory responses remains unclear.
- Septic shock in invasive meningococcal disease presents with circulatory, respiratory, and renal failure, often unresponsive to standard treatments.
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