A case of toxic shock-like syndrome due to spontaneous bacterial peritonitis successfully treated with continuous hemodiafiltration involving two consoles using a polymethylmethacrylate membrane hemofilter (double PMMA-CHDF)

Abstract

A patient with liver cirrhosis due to primary sclerosing cholangitis developed spontaneous bacterial peritonitis (SBP) and developed toxic shock-like syndrome (TSLS) caused by Streptococcus pyogenes. In addition to conventional intensive care strategies, continuous hemodiafiltration (CHDF) involving two consoles using a polymethylmethacrylate (PMMA) membrane hemofilter (double PMMA-CHDF) was performed. The patient successfully recovered from refractory shock through improvement of hypercytokinemia. The pathophysiology of TSLS is thought to be hypercytokinemia induced by the reaction of streptococcal pyrogenic exotoxin (SPE), which possesses superantigenic activity with T cell receptor. Therefore, it is suggested that double PMMA-CHDF may have a role in controlling hypercytokinemia irresponsive to conventional treatment strategies.