2023 Volume 56 Issue 1 Pages 11-17
An 82-year-old male with a 2-year history of hemodialysis for end-stage renal disease due to diabetic kidney disease was admitted because of fever, epigastralgia, and chest and back pain that had persisted for two weeks. For a year prior to hospitalization, he had been treated with oral prednisolone because of pulmonary hemorrhage due to suspected vasculitis. On admission, laboratory findings showed marked elevation of inflammatory markers, and computed tomography revealed emphysematous cholecystitis, lower bile duct stones, and infected aortitis with a pseudoaneurysm in the thoracic aorta. Despite immediate antibacterial therapy, the patient developed septic shock. Therefore, endotoxin adsorption therapy using Polymyxin B Immobilized Fiber Column (Polymyxin B Immobilized Fiber Column direct hemoperfusion (PMX-DHP)) was administered for 2 days starting from day 2 after hospitalization. Even though Clostridium perfringens was detected in blood culture, adsorption therapy was effective for increasing the blood pressure. Endoscopic retrograde cholangiopancreatography was safely performed for bile duct drainage on day 16. However, enlargement of the pseudoaneurysm was subsequently confirmed. Therefore, endovascular repair with a stent graft was conducted on day 28. Consequently, the patientʼs general condition gradually improved, and he was discharged on the 77th hospital day. To our knowledge, it is commonly accepted that infection with Clostridium perfringens is associated with a therapy-resistant clinical course and poor prognosis for compromised hosts, like our case. The present case involved an elderly hemodialysis patient under steroid therapy, and so his clinical condition was impaired regarding infection control. However, we could achieve a favorite outcome, possibly attributable to the use of non-invasive and effective therapy comprising PMX-DHP and endovascular aortic repair in addition to drainage of the site of infection.
