Polymyxin-B immobilized column-direct hemoperfusion for adolescent toxic shock syndrome.
Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well.
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. nanishi@pediatr.med.kyushu-u.ac.jp.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan. nanishi@pediatr.med.kyushu-u.ac.jp.
Etsuro
E
Nanishi
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Yuichirou
Y
Hirata
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Sooyoung
S
Lee
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Noriyuki
N
Kaku
Department of Orthopedics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Kenta
K
Momii
Department of Orthopedics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Kensuke
K
Kubota
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Hisanori
H
Nishio
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
Yoshihiko
Y
Maehara
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Toshiro
T
Hara
D000293:Adolescent; D004867:Equipment Design; D016908:Gram-Positive Bacterial Infections / Q000628:therapy*; D006464:Hemoperfusion / Q000295:instrumentation*; D006801:Humans; D008297:Male; D011112:Polymyxin B; D012772:Shock, Septic / Q000635:transmission*; D016896:Treatment Outcome
D011112:Polymyxin B
direct hemoperfusion; pediatric; polymyxin-B immobilized fiber; toxic shock syndrome