title: Intravenous gammaglobulin as rescue therapy in a patient with sickle cell and septic shock.
abstract: BACKGROUND
  We present a case involving a patient with sickle cell and hyposplenism, in which refractory septic shock quickly responded after the infusion of intravenous gammaglobulin (IV-GG) given as an adjuvant-rescue therapy
  
  
  METHODS
  A 30-year-old African-American female with history of Sickle Cell disease was admitted for acute chest syndrome, septic shock and respiratory failure. Despite aggressive therapy the patient remained on two vasopressors and with persistent bacteremia. Within one day of starting IV-GG, both vasopressors (norepinephrine and vasopressin) were able to be discontinued.
  
  
  CONCLUSIONS
  Patients with hyposplenism have functional opsonization failure. Infusion of IV-GG has been shown to improve such function in patients with hyposplenism. We were able to document a temporal association between IV-GG rescue therapy and septic shock improvement.
  
  
  CONCLUSIONS
  The utilization of intravenous gammaglobulin should be considered in patients with sickle cell disease and hyposplenism as an adjuvant therapy for refractory septic shock.
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, TN, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Romero-Legro
authors.forename: Dipen
authors.initials: D
authors.lastname: Kadaria
authors.forename: Luis C
authors.initials: LC
authors.lastname: Murillo
authors.forename: Amado X
authors.initials: AX
authors.lastname: Freire
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy*; D013154:Spleen / Q000002:abnormalities; D017211:Treatment Failure
chemical_list: D016756:Immunoglobulins, Intravenous