ABSTRACT
A 70-year-old woman with a history of aortic valve replacement and coronary artery bypass grafting (CABG) was transferred to the authors' hospital for further management of a three-month fever of unknown origin. Computed tomography showed a huge mass in the ascending aorta with pseudoaneurysm. Blood ß-D-glucan levels were significantly high, and blood culture showed the growth of Candida albicans. The fungus ball was excised surgically, together with aortic root replacement and CABG, followed by six-month postoperative anti-fungal therapy. Early diagnosis by imaging studies followed by aggressive surgery and long-term postoperative antifungal treatment should result in a favorable outcome.
Subject(s)
Aneurysm, False/microbiology , Aneurysm, False/surgery , Aorta/microbiology , Aorta/surgery , Candida albicans/isolation & purification , Candidiasis/diagnosis , Candidiasis/surgery , Aged , Aortic Valve Stenosis/surgery , Coronary Artery Bypass , Female , Heart Valve Prosthesis Implantation , HumansABSTRACT
Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well.
