2006 Volume 80 Issue 3 Pages 257-261
A 75-year-old woman was admitted with fever of unknown origin and liver damage, and treated withprednisolone. Hypercalcemia appeared when of the dose of prednisolone was reduced, and human T-celllymphotropic virus type-I (HTLV-I) proviral DNA was detected in the leukemic cells by Southern blot analysis, and a diagnosis of acute adult T-cell lymphoma (ATL) was made. After chemotherapy with sobuzoxanewas started, she went into septic shock caused by multiple resistant Serratia marcesense, and was treatedwith PMX-DHP and antibiotics. Although ner general condition and her serum cytokine leyels improved, theseptic shock became more severe, and the patient died.
Serratia marcesense expreses lipopolysaccharide (LPS), a biologically active substance that is present ingram-negative bacteria.Exposure to LPS leads to activation of cytoklnes, including TNF-α, IL-1β, IL-6, andIFN-γ.After treatment withPMX-DHP, the patien, s general condition improved, but she died of septicshock. Bacterial infection may be a life-threatening complication in the immunocompromised hosts and elderlypatients, particularly when granulocytopenia has been induced by chemotherapy, and thus such thesepatients require careful management.
