Successful treatment of sepsis due to Pantoea agglomerans by polymyxin B-immobilized fiber column direct hemoperfusion therapy in a small cell lung carcinoma patient

Abstract

Sepsis is a life-threatening condition caused by the inflammatory response to invading organisms. Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is used to reduce blood endotoxin levels and modulate circulating inflammatory cytokine levels in sepsis patients. Here we report that severe sepsis caused by an infection of the gram-negative bacterium Pantoea agglomerans in a patient with small cell lung carcinoma was treated successfully with antibiotics and PMX-DHP. The patient, a 49-year-old Japanese male smoker whose condition was complicated with hyponatremia due to SIADH (syndrome of inappropriate secretion of antidiuretic hormone), rapidly developed sepsis and disseminated intravascular coagulation (DIC) after the administration of cisplatin and irinotecan. Despite initial antibiotics therapy, severe host responses including hypotension, high body temperature and tachycardia were noted. We initiated PMX-DHP, and the patient's Sequential Organ Failure Assessment score was greatly reduced and his DIC improved immediately. To our knowledge, this is the first reported case of PMX-DHP therapy for severe sepsis caused by P. agglomerans infection. Although the efficacy of PMX-DHP in sepsis is not well defined, PMX-DHP therapy should be considered in cases of sepsis from gram-negative infections.

Keywords: PMX-DHP; Pantoea agglomerans; SCLC; SIADH; Sepsis.

Fig. 1

Chest CT at the diagnosis of SCLC and 3 months later at admission. (A) Chest CT at the diagnosis of SCLC (3 months prior to this admission) in the patient, a 49-year-old Japanese male smoker. The chest CT shows the primary tumor shadow in the left superior lobe and lymph node metastasis in the mediastinum. (B) Chest CT on admission. Reductions of size in both the primary tumor shadow and the lymph node metastasis are observed.

Fig. 2

Chest X-ray on transfer to the intensive care unit. Chest X-ray on transfer to the ICU. The chest X-ray shows enlargement of left hilar shadow (arrow) without consolidations.

Fig. 3

Clinical course in the intensive care unit. Changes in the SOFA score, DIC score, CRP level and lactate level. After PMX-DHP treatment and the administration of antibiotics, the SOFA score, DIC score, and CRP level dropped from 11 to 3, from 7 to 1, and from 24.4 mg/dl to 3.3 mg/dl, respectively during the patient's 5-day stay in the ICU.