We report a case of septic shock treated with PMX-DHP that was complicated with Lemierre syndrome caused by Fusobacterium necrophorum. The patient was a 31-year-old man who was initially diagnosed with influenza. He received treatment; however, because his symptoms gradually worsened, he was transported to our hospital 10 days following his diagnosis. His initial examination revealed symptoms of respiratory distress and an altered level of consciousness. Based on laboratory and imaging results, it became clear that he suffered from septic shock of unknown etiology, disseminated intravascular coagulation, and acute renal and respiratory failure. We initiated treatment with vasopressors, an antibacterial agent, immunoglobulins as well as an appropriate ventilator management; however, his unstable circulatory condition continued. As soon as PMX-DHP was initiated, 2 days following admission to the ICU, his circulatory instability normalized. F. necrophorum was ultimately detected after a culture examination, and contrast-enhanced computed tomography revealed a jugular vein thrombus, which led to the diagnosis of Lemierre syndrome. The patient’s condition gradually improved, and he was discharged from the ICU after 19 days.

A newly developed semi-automatic synthetic luminescence substrate (SALS) method for measuring endotoxin was compared with the existing turbidimetric kinetic assay (TKA) using leukocyte-rich plasma to verify its usefulness. As a result, the endotoxin levels by this method were higher than that by the existing assay in most specimens, and the time required for measurement was much shorter. In addition, the leukocyte-rich plasma endotoxin level minus the plasma endotoxin levels were named leukocyte-associated endotoxin, and these levels per one leukocyte were compared. As a result, those levels were highly correlated with the endotoxin measurement levels of leukocyte-rich plasma. The correlation coefficient of SALS method was superior to the existing TKA method, the endotoxin level by this method may be close to true endotoxin levels.

No abstract

The plasma sample, which contains almost no leukocytes, is generally used to measure endotoxin levels in blood. However, it is known that the diagnostic ability is not high. We assumed that most endotoxins exist in a state trapped by leukocytes, and then we have devised a method (LRP37 method) to obtain leukocyte-rich plasma (LRP) for measuring blood endotoxins. In this study, we selected the following two methods for measuring endotoxins in the LRP; the conventional turbidimetric kinetic assay (TKA) and the semi-automated luminescent substrate method (SALS) using the leukocyte fraction obtained the LRP. The endotoxin levels obtained from these methods were compared with the diagnostic ability of existing sepsis markers. The target cases were 40 who were admitted to our institution. Comparing the non-infected group with the Gram-negative infected group, the area under the curve of TKA and SALS were 0.94 and 0.86, respectively, and these diagnostic capabilities were the best among all the markers tested.