腎孟腎炎による敗血症に対して,エンドトキシン吸着療法が有効であった2型糖尿病の1例

Abstract

A case of type 2 diabetes mellitus treated successfully by endotoxin adsorption therapy for sepsis caused by pyelonephritis is reported. The patient was a 56-year-old woman, referring to our hospital for type 2 diabetes mellitus and essential hypertension. On January 31, 2001, she was admitted to our hospital because of left lateroabdorninal pain and frequent vomiting. Physical examination revealed blood pressure 130/80mmHg, heart rate 84/min, and body temperature 36.9℃. There was tenderness of the left flank and percussion pain of the left back. Blood examination revealed 8,000 white blood cells/μL, a CRP level of O.2mg/dL, and 108,000 platelets/μL. Urinary sediment revealed a white blood cell count of 30-49/HPF and bacteria positive. Abdominal CT on admission showed huge myoma uteri and dilation of the left renal pelvis. Therefore the case was diagnosed as hydronephrosis due to obstruction of the urinary tract and treated with antibiotics. But on the second hospital day, body temperature rose to 40℃ and Escherichia coli was detected by blood culture. On the 6th hospital day, blood examination revealed 38,000 white blood cells/μL, a CRP level of 13.9 mg/dL, and 16,000 platelets/μL, so the case was diagnosed as sepsis caused by acute pyelonephritis with disseminated intravascular coagulation (DIC) and treated by endotoxin adsorption therapy twice. Fever was diminishing after the 8th hospital day and on the 10th hospital day blood examination revealed 7,200 white blood cells/μL, a CRP level of 3.5mg/dL, and 112,000 platelets/μL. After that the clinical course was good, so she was discharged on the 40th hospital day.