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Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption

BACKGROUND: Sepsis and septic shock are still life-threatening diseases with a high mortality rate. We report a complex case of peritonitis with pericarditis and acute liver failure caused by septic shock. Potentially hepatotoxic antibiotic therapy levels were monitored using the liver maximum capac...

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Autores principales: Köhler, Thomas, Pletz, Mathias W., Altmann, Simon, Kirchner, Carmen, Schwier, Elke, Henzler, Dietrich, Winde, Günther, Eickmeyer, Claas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987411/
https://www.ncbi.nlm.nih.gov/pubmed/33815848
http://dx.doi.org/10.1155/2021/8824050
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author Köhler, Thomas
Pletz, Mathias W.
Altmann, Simon
Kirchner, Carmen
Schwier, Elke
Henzler, Dietrich
Winde, Günther
Eickmeyer, Claas
author_facet Köhler, Thomas
Pletz, Mathias W.
Altmann, Simon
Kirchner, Carmen
Schwier, Elke
Henzler, Dietrich
Winde, Günther
Eickmeyer, Claas
author_sort Köhler, Thomas
collection PubMed
description BACKGROUND: Sepsis and septic shock are still life-threatening diseases with a high mortality rate. We report a complex case of peritonitis with pericarditis and acute liver failure caused by septic shock. Potentially hepatotoxic antibiotic therapy levels were monitored using the liver maximum capacity (LiMAx®) test, and standard treatment was supplemented by adjunctive hemoadsorption with CytoSorb®. Case Presentation. The case features a 29-year-old woman with a history of Crohn's disease and cachexia. Peritonitis caused by Enterococcus faecium was diagnosed later due to an ileum perforation. The hematogenic spread led to pericarditis. In addition, sepsis-related acute liver failure complicated antimicrobial therapy further. The combination of standard therapy, anti-infective medication, and blood purification was associated with inflammation control, hemodynamic stabilization, and a concomitant decrease in vasopressor support. An efficient, sustained reduction in plasma bilirubin levels was achieved while maintaining liver function. CONCLUSIONS: This case shows how complex infectious diseases with an atypical infectious focus resulting in septic shock can be successfully treated. A combination of antimicrobial (tigecycline and caspofungin) and long-term adjunctive hemoadsorption therapy was administered while hepatotoxic antibiotic medication was monitored by liver function testing.
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spelling pubmed-79874112021-04-02 Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption Köhler, Thomas Pletz, Mathias W. Altmann, Simon Kirchner, Carmen Schwier, Elke Henzler, Dietrich Winde, Günther Eickmeyer, Claas Case Rep Crit Care Case Report BACKGROUND: Sepsis and septic shock are still life-threatening diseases with a high mortality rate. We report a complex case of peritonitis with pericarditis and acute liver failure caused by septic shock. Potentially hepatotoxic antibiotic therapy levels were monitored using the liver maximum capacity (LiMAx®) test, and standard treatment was supplemented by adjunctive hemoadsorption with CytoSorb®. Case Presentation. The case features a 29-year-old woman with a history of Crohn's disease and cachexia. Peritonitis caused by Enterococcus faecium was diagnosed later due to an ileum perforation. The hematogenic spread led to pericarditis. In addition, sepsis-related acute liver failure complicated antimicrobial therapy further. The combination of standard therapy, anti-infective medication, and blood purification was associated with inflammation control, hemodynamic stabilization, and a concomitant decrease in vasopressor support. An efficient, sustained reduction in plasma bilirubin levels was achieved while maintaining liver function. CONCLUSIONS: This case shows how complex infectious diseases with an atypical infectious focus resulting in septic shock can be successfully treated. A combination of antimicrobial (tigecycline and caspofungin) and long-term adjunctive hemoadsorption therapy was administered while hepatotoxic antibiotic medication was monitored by liver function testing. Hindawi 2021-03-16 /pmc/articles/PMC7987411/ /pubmed/33815848 http://dx.doi.org/10.1155/2021/8824050 Text en Copyright © 2021 Thomas Köhler et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Köhler, Thomas
Pletz, Mathias W.
Altmann, Simon
Kirchner, Carmen
Schwier, Elke
Henzler, Dietrich
Winde, Günther
Eickmeyer, Claas
Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title_full Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title_fullStr Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title_full_unstemmed Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title_short Pericarditis Caused by Enterococcus faecium with Acute Liver Failure Treated by a Multifaceted Approach including Antimicrobials and Hemoadsorption
title_sort pericarditis caused by enterococcus faecium with acute liver failure treated by a multifaceted approach including antimicrobials and hemoadsorption
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987411/
https://www.ncbi.nlm.nih.gov/pubmed/33815848
http://dx.doi.org/10.1155/2021/8824050
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