title: [Septic shock induced by Serratia marcescens complicating adult T-cell leukemia (ATL)].
abstract: A 75-year-old woman was admitted with fever of unknown origin and liver damage, and treated with prednisolone. Hypercalcemia appeared when of the dose of prednisolone was reduced, and human T-cell lymphotropic virus type-I (HTLV-I) proviral DNA was detected in the leukemic cells by Southern blot analysis, and a diagnosis of acute adult T-cell lymphoma (ATL) was made. After chemotherapy with sobuzoxane was started, she went into septic shock caused by multiple resistant Serratia marcesense, and was treated with PMX-DHP and antibiotics. Although ner general condition and her serum cytokine leyels improved, the septic shock became more severe, and the patient died. Serratia marcesense expreses lipopolysaccharide (LPS), a biologically active substance that is present in gram-negative bacteria. Exposure to LPS leads to activation of cytokines, including TNF-alpha, IL-1beta, IL-6, and IFN-gamma. After treatment with PMX-DHP, the patient's general condition improved, but she died of septic shock. Bacterial infection may be a life-threatening complication in the immunocompromised hosts and elderly patients, particularly when granulocytopenia has been induced by chemotherapy, and thus such these patients require careful management.
authors.affiliation: First Department of Internal Medicine, Osaka Medical College.
authors.forename: Satoko
authors.initials: S
authors.lastname: Oka
authors.forename: Taiji
authors.initials: T
authors.lastname: Yokote
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Akioka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hara
authors.forename: Kichinosuke
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yuuji
authors.initials: Y
authors.lastname: Hirata
authors.forename: Motomu
authors.initials: M
authors.lastname: Tuji
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Hanafusa
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D015458:Leukemia, T-Cell / Q000150:complications*; D016868:Serratia Infections / Q000150:complications*; D012706:Serratia marcescens; D012772:Shock, Septic / Q000150:complications*