Emphysematous cholecystitis and infective pseudoaneurysm caused by <i>clostridium perfringens</i> in an elderly hemodialysis patient under immunosuppressive therapy, against which PMX-DHP and endovascular stent grafting were effective

Abstract

3 Saka Clinic； 4 Sagamiono Medical and Kidney Clinic Keywords： Clostridium perfringens, hemodialysis, infectious aneurysm, endovascular aortic repair, PMX DHP 〈Abstract〉 An 82 year old male with a 2 year history of hemodialysis for end stage renal disease due to diabetic kidney disease was admitted because of fever, epigastralgia, and chest and back pain that had persisted for two weeks. For a year prior to hospitalization, he had been treated with oral prednisolone because of pulmonary hemorrhage due to suspected vasculitis. On admission, laboratory findings showed marked elevation of inflammatory markers, and computed tomography revealed emphysematous cholecystitis, lower bile duct stones, and infected aortitis with a pseudoaneurysm in the thoracic aorta. Despite immediate antibacterial therapy, the patient developed septic shock. Therefore, endotoxin adsorption therapy using Polymyxin B Immobilized Fiber Column (Polymyxin B Immobilized Fiber Column direct hemoperfusion (PMX DHP)) was administered for 2 days starting