Treatment of severe sepsis secondary to mycobacterium avium-intracellulare with recombinant human activated protein C.
BACKGROUND
Mycobacterium avium-intracellulare (MAI) is a well-described pathogen in patients with acquired immune deficiency syndrome (AIDS). However, peritonitis and severe sepsis as a complication of disseminated MAI is rare. We report a case that represents the first successful use of recombinant human activated protein C (rhAPC) in the treatment of severe sepsis secondary to mycobacterial infection and only the second reported case of MAI peritonitis with no known predisposing factor other than AIDS.


METHODS
Case report and review of the pertinent literature.


RESULTS
A 36-year-old man with AIDS presented to the emergency department with acute-onset right-sided abdominal pain, fever, and chills. Abdominal computed tomography revealed multiple rim-enhancing fluid collections. Despite immediate surgical drainage and debridement and appropriate antimicrobial therapy targeting the non-tuberculous acid-fast bacilli found in intraperitoneal fluid, the patient developed severe sepsis and septic shock. Clinical improvement occurred after infusion of recombinant human activated protein C (rhAPC) and specific antimicrobial chemotherapy directed against MAI.


CONCLUSIONS
Treatment with rhAPC decreases the mortality rate of bacterial sepsis of abdominal origin and may confer a similar benefit in the treatment of abdominal mycobacterial sepsis.
Ullery
Brant
B
Department of Surgery, Weill Medical College of Cornell University, New York, New York, USA.
Pieracci
Fredric M
FM
Hydo
Lynn J
LJ
Eachempati
Soumitra R
SR
Barie
Philip S
PS
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D015269:Mycobacterium avium Complex / Q000187:drug effects*; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000382:microbiology; D010538:Peritonitis / Q000188:drug therapy* / Q000382:microbiology; D011486:Protein C / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy* / Q000382:microbiology; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D011486:Protein C; D011994:Recombinant Proteins; C421124:drotrecogin alfa activated