Sepsis is often associated with a downward spiral through a spectrum of systemic inflammatory response syndrome (SIRS) culminating in organ failure and death. Here we present a 3-year-old girl with Hemophilus influenzae septic meningitis who developed SIRS and acute renal failure. In the initial stage, the patient showed uremia, cytopenia, disseminated intravascular coagulation, elevation of tissue enzyme and ferritin values, hemophagocytosis and overproduction of nitric oxide. The serum cytokine profile revealed increased levels of soluble interleukin (IL)-2 receptor, IL-6, IL-10 and tumor necrosis factor α. The patient responded positively to early and intensive interventions including antibiotics, repeated exchange transfusions, dexamethasone and high-dose γ-globulin. The above laboratory abnormalities almost normalized with clinical improvement. We consider that SIRS was probably responsible for the sequence of events resulting in renal failure in this case, and suggest that renal failure should be included among the serious complications of SIRS associated with Hemophilus influenzae septic meningitis.

(Objective) Intravenous gamma globulin (IVGG) treatment is the most important therapy in the Kawasaki disease (KD), however there are many uncertainties about active mechanism of this treatment. This time, we examined active mechanisms of IVGG treatment affecting on apoptosis of neutrophils. (Patients and controls) Fifteen subjects (4 months ϳ 4 years old) were selected from the KD patients who had been admitted to Dokkyo University Hospital between June, 2000 and May, 2001. Healthy adults were used as controls.(Materials and methods) (1) Neutrophils were separated from heparinized blood by the specific gravity centrifugation. (2) Venoglobulin-I was used as human IgG for this experiment. (3) Apoptosis was determined with microscopic examination and flow cytometry. DNA quantity of the cells stained with PI alone and PI and anexin V was measured in flow cytometry.(Results) (1) Spontaneous apoptosis on KD patient neutrophils was more delayed than that on controls, as the picking illness day was earlier. (2) When healthy adult neutrophils was cultured in the presence of IgG (1mg/ml), apoptosis was promoted, but this effect was not observed under less than 0.1mg/ml IgG. Therefore, IgG was used at the concentration of 1mg/ml in further experiments. (3) The morphological changes unlike control neutrophils were observed on KD patient neutrophils after the culture in the presence of IgG. (4) Based on apoptosis pattern of neutrophils in the presence of IgG, samples were divided into two groups, promoted example and not. The promotion of apoptosis by the IgG addition in vitro was observed in about half of samples from the patients, in which IVGG gave more remarkable effects clinically. (Conclusions) We considered the possibility in which one part of the clinical effects of IVGG treatment had appeared by promoting the apoptotic effects to neutrophils.