[Septic shock following flexible transurethral lithotripsy showing favourable response after multidisciplinary treatment mainly composed of recombinant thrombomodulin : a case report].
We herein present a case of a 65-year-old woman who developed severe septic shock following flexible transurethral lithotripsy (f-TUL) showing favourable response after treatment with doripenem and recombinant thrombomodulin (rTM). The patient underwent f-TUL for nephrolithiasis of the left kidney. Preoperative urine culture indicated the presence of a mucoid strain of E. coli that was susceptible to cefazolin ; therefore, the antibiotic cefazolin was administered as a preventive measure. The operation was completed without any specific intraoperative complications. On the day following the operation, blood pressure decreased and clouding of consciousness was observed. Hematological examination showed high levels of procalcitonin, a decrease in platelet count, and high levels of fibrin degradation products (FDP), indicative of severe septic shock and disseminated intravascular coagulation (DIC). The patient was immediately shifted to the intensive care unit (ICU), and multidisciplinary treatment consisting of doripenem (3 g/day) and rTM (380 U/kg) was administered. The medical treatment was successful ; the patient recovered from DIC at an early stage and was able to leave the hospital within 10 days after the operation. The risk of complications is expected to increase with the spread of f-TUL, and prompt action must be taken.
The Department of Urology, Gunma University Graduate School of Medicine, Japan.
Haruo
H
Kato
Yasuhiro
Y
Shibata
Tomomi
T
Suzuki
Kazuto
K
Ito
Kazuhiro
K
Suzuki
D000368:Aged; D015780:Carbapenems / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000077726:Doripenem; D005260:Female; D006801:Humans; D008096:Lithotripsy / Q000009:adverse effects* / Q000379:methods; D011994:Recombinant Proteins / Q000627:therapeutic use; D012772:Shock, Septic / Q000209:etiology / Q000628:therapy*; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome
D015780:Carbapenems; D011994:Recombinant Proteins; D018180:Thrombomodulin; D000077726:Doripenem