A 33-year-old woman visited the emergency department presenting with fever and dyspnea. She was pregnant with gestational age of 31 weeks and 6 days. She had dysuria for 7 days, and fever and dyspnea for 1 day. The vital signs were as follows: blood pressure 110/70 mmHg, heart rate 118 beats/minute, respiratory rate 28/minute, body temperature 38.7℃, and oxygen saturation by pulse oximetry 84% during inhalation of 5 liters of oxygen by nasal prongs. Crackles were heard over both lung fields. There were no signs of uterine contractions. Chest X-ray and chest computed tomography scan showed multiple consolidations and air bronchograms in both lungs. According to urinalysis, there was pyuria and microscopic hematuria. She was diagnosed with community-acquired pneumonia and urinary tract infection (UTI) that progressed to severe sepsis and acute respiratory failure. We found extended-spectrum beta-lactamase producing Escherichia coli in the blood culture and methicillin-resistant Staphylococcus aureus in the sputum culture. The patient was transferred to the intensive care unit with administration of antibiotics and supplementation of high-flow oxygen. On hospital day 2, hypoxemia was aggravated. She underwent endotracheal intubation and mechanical ventilation. After 3 hours, fetal distress was suspected. Under 100% fraction of inspired oxygen, her oxygen partial pressure was 87 mmHg in the arterial blood. She developed acute kidney injury and thrombocytopenia. We diagnosed her with multi-organ failure due to severe sepsis. After an emergent cesarean section, pneumonia, UTI, and other organ failures gradually recovered. The patient and baby were discharged soon thereafter.

Background: Alpha-lipoic acid (aLA) is a strong antioxidant commonly used for treatment of diabetic polyneuropathy (DPNP). Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on stroke patients remain unknown. This study investigated whether patients treated with aLA for acute ischemic stroke (AIS) after reperfusion therapy have a better functional outcome than aLA-naïve patients. Methods: In a prospective observational cohort study of 172 patients with DPNP and AIS treated with tissue plasminogen activator (tPA), we investigated the relationship between aLA use and functional outcome at 3 months and 1 year, the occurrence of hemorrhagic transformation (HT), early neurological deterioration (END), and early clinical improvement (ECI). The functional outcomes of patients were categorized as favorable (modified Rankin Scale [mRS] score 0-2) or unfavorable (mRS score 3-6). We defined END as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale (NIHSS) score and ECI as a decrease of ≥4 points in NIHSS score within 7 days. Ischemic stroke subtypes were defined according to the TOAST classification. Results: Of the 172 AIS with DPNP patients included, 47 (27.3%) used aLA for DPNP. In the entire cohort, those treated with aLA had a significantly higher rate of a favorable outcome at 3 months (55.3 vs. 33.6%, p < 0.01) and 1 year (57.4 vs. 34.4%, p < 0.01) compared with their counterparts. The risks of END and HT were significantly lower and the percentages of ECI were significantly higher in those treated with aLA. In the multivariable analysis, aLA use was associated with favorable outcome at 3 months (OR = 2.13, 95% CI = 1.01-4.51, p = 0.048) and 1 year (OR = 2.26, 95% CI = 1.06-4.84, p = 0.036). Age, HT, and increasing NIHSS scores were negative predictors of favorable outcome. Conclusions: aLA use for AIS with DPNP patients treated with tPA is associated with favorable outcome. These results indicate that aLA could be a useful intervention for the treatment of AIS after reperfusion therapy.