Treatment of severe sepsis secondary to mycobacterium avium-intracellulare with recombinant human activated protein C.

Abstract:

BACKGROUND:Mycobacterium avium-intracellulare (MAI) is a well-described pathogen in patients with acquired immune deficiency syndrome (AIDS). However, peritonitis and severe sepsis as a complication of disseminated MAI is rare. We report a case that represents the first successful use of recombinant human activated protein C (rhAPC) in the treatment of severe sepsis secondary to mycobacterial infection and only the second reported case of MAI peritonitis with no known predisposing factor other than AIDS. METHODS:Case report and review of the pertinent literature. RESULTS:A 36-year-old man with AIDS presented to the emergency department with acute-onset right-sided abdominal pain, fever, and chills. Abdominal computed tomography revealed multiple rim-enhancing fluid collections. Despite immediate surgical drainage and debridement and appropriate antimicrobial therapy targeting the non-tuberculous acid-fast bacilli found in intraperitoneal fluid, the patient developed severe sepsis and septic shock. Clinical improvement occurred after infusion of recombinant human activated protein C (rhAPC) and specific antimicrobial chemotherapy directed against MAI. CONCLUSIONS:Treatment with rhAPC decreases the mortality rate of bacterial sepsis of abdominal origin and may confer a similar benefit in the treatment of abdominal mycobacterial sepsis.

journal_name

Surg Infect (Larchmt)

journal_title

Surgical infections

authors

Ullery B,Pieracci FM,Hydo LJ,Eachempati SR,Barie PS

doi

10.1089/sur.2007.050

subject

Has Abstract

pub_date

2008-06-01 00:00:00

pages

389-94

issue

3

eissn

1096-2964

issn

1557-8674

journal_volume

9

pub_type

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