Use of Direct Hemoperfusion with Polymyxin B-Immobilized Fiber for the Treatment of Septic Shock Complicated with Lemierre Syndrome Caused by Fusobacterium necrophorum

Abstract

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 Review of the Potential of Hemoperfusion for the Treatment of Patients with Respiratory Infectious Diseases with COVID-19 Approach

“…The results of a study of patients with severe sepsis and acute respiratory distress syndrome showed that although interleukin-6 is eliminated through hemoperfusion, this method has no effect on reducing the level of this biomarker in the blood [42]. Also, based on the results of the previous study, the use of hemoperfusion in patients with septic shock has led to improved clinical conditions and increased patient survival [43]. However, past efforts to control inflammation in these patients have generally failed [43].…”

“…Also, based on the results of the previous study, the use of hemoperfusion in patients with septic shock has led to improved clinical conditions and increased patient survival [43]. However, past efforts to control inflammation in these patients have generally failed [43]. Although the use of methods such as hemofiltration and hemodiafiltration more successfully removes molecules such as cytokines than hemodialysis, they do not significantly improve the patient's clinical condition [44].…”

An Unusual Variant of Lemierre’s Syndrome with Multiple Abscesses and Hepatic Vein Thrombosis

“…Lemierre's syndrome (LS) is an uncommon, lifethreatening disease with an incidence rate of 0.6 to 2.3 cases per million people and a mortality rate of 4% -22% (1). It is a septic thrombophlebitis of the internal jugular vein (IJV) paralleled with embolic abscesses, which develops as a severe complication of oropharyngeal infection (2).…”