We present a case of 71-year-old man who developed severe septic shock following transurethral resection of prostate (TURP) and cystolitholapaxy (CLL), showing favorable response after multidisciplinary treatment consisting PMX-DHP and CHDF. The patient underwent TURP for prostatic hypertrophy and CLL for bladder stone. The operation was completed with no intraoperative complications. 3 days after operation, a 39.8°C fever, blood pressure decreased and clouding of the consciousness were observed. The patient was transferred to the intensive care unit (ICU) and treated with mechanical ventilation and appropriate drug therapy. 5 hours after admission to the ICU, first PMX-DHP treatment was performed for 16 hours, but hemodynamics was not improved and became no urination. Second PMX-DHP and CHDF treatment performed 9 hours after first PMX-DHP. After second PMX-DHP the patient got stable hemodynamics and sufficient urine volume. Mechanical ventilation was ended 9 days after the ICU admission and moved to the general ward.
Due to the impaired peripheral perfusion during hemodynamic crisis, all toes and 2 fingers were necrosis and amputated. After 6 months of rehabilitation, he discharged to home.
