Rapidly Progressive Interstitial Pneumonia Associated with Clinically Amyopathic Dermatomyositis Successfully Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion

Kakugawa, Tomoyuki; Mukae, Hiroshi; Saito, Masataka; Ishii, Koji; Ishimoto, Hiroshi; Sakamoto, Noriho; Takazono, Takahiro; Fukuda, Yuichi; Ooe, Nobuharu; Kohno, Shigeru

doi:10.2169/internalmedicine.47.0639

Cited by 30 publications

(21 citation statements)

References 28 publications

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“…As an addition to a previous study reporting that CCL4 interacted (41,42). In accordance with the results of the present study, TIMP1 was also identified to be associated with interstitial pneumonia (43,44). CTSB belongs to a family of lysosomal cysteine proteases and is encoded by the CTSB gene in humans (45,46).…”

Section: Discussionsupporting

confidence: 92%

Gene expression analysis for pneumonia caused by Gram-positive bacterial infection

et al. 2018

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Abstract. Gram-positive bacteria are an important pathogenic factor for bacterial pneumonia. The aim of the present study was to identify the differentially expressed genes (DEGs) and to explore their associated pathways or expression patterns. Expression profiling of gene arrays from two independent datasets, GSE6269 and GSE35716, were downloaded from the Gene Expression Omnibus. The DEGs between peripheral blood samples from healthy controls and patients with bacterial pneumonia were identified. The Functional Annotation Tool in the Database for Annotation, Visualization and Integrated Discovery was used to annotate and analyze the DEGs in Gene Ontology (GO) terms and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways. Multiple proteins were used to generate a protein-protein interaction (PPI) network. A total of 624 (621 annotated) were identified in the GSE6269 dataset and 398 (295 annotated) DEGs were identified in the GSE35716 dataset between pneumonia and healthy samples. A total of 40 common DEGs were identified between the 2 datasets, including 4 downregulated and 32 upregulated DEGs. In the GO category cellular component, melanosome was highly enriched among 11 genes; in the category biological process, the three most enriched items were regulation of ruffle assembly, negative regulation of calcium ion transport and necroptotic process. In the KEGG terms, only the nuclear factor-κB signaling pathway (Homo sapiens 04064) was significantly enriched. In the PPI network, five genes (CCL4, TIMP metallopeptidase inhibitor 1, intercellular adhesion molecule 1, plasminogen activator, urokinase receptor and cathepsin B) were identified to have a high degree of interaction with other DEGs. In conclusion, these five genes may represent key genes associated with pneumonia caused by Gram-positive bacteria. All of these results provide primary information and basic knowledge to understand the mechanisms of the pathogenesis.

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Section: Discussionsupporting

confidence: 92%

Gene expression analysis for pneumonia caused by Gram-positive bacterial infection

et al. 2018

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“…Fourthly, the number of courses and the time duration per one course may be critical. Reports which used PMX-DHP treated with different durations for 3-24 hours with 1-6 courses (3,4,12). While the number of courses and the time length per one course may be critical, the best protocol still remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite routine use of high dose corticosteroids and immunosuppressive agents, some cases are hard to treat. While some report the efficacy of direct hemoperfusion with a Polymyxin B immobilized fiber column (PMX-DHP) (3,4) and intravenous immunoglobulin (IVIG) (5), the efficacy and the safety of the PMX-DHP and IVIG combination are controversial. We herein report a case of rapidly progressive ILD associated with DM which survived with the administration of PMX-DHP and IVIG in addition to high dose corticosteroids and immunosuppressive agents.…”

Section: Introductionmentioning

confidence: 99%

Rapidly Progressive Interstitial Lung Disease Associated with Dermatomyositis Treated with Combination of Immunosuppressive Therapy, Direct Hemoperfusion with a Polymyxin B Immobilized Fiber Column and Intravenous Immunoglobulin

et al. 2015

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Rapidly progressive interstitial lung disease (ILD) is associated with dermatomyositis (DM) and has a high mortality rate even with immunosuppressive agents. For such cases, there is no evidence on the combined effect of direct hemoperfusion with a Polymyxin B immobilized fiber column and intravenous immunoglobulin. We herein report a case of 61-year-old woman who presented with respiratory failure. She showed ILD associated with DM which did not improve with immunosuppressive agents, but was improved with the addition of both direct hemoperfusion with a Polymyxin B immobilized fiber column and intravenous immunoglobulin.

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“…Nemoto et al 9) suggested that 1 or 2 courses of adsorption for 4 hours each improved the survival of patients with sepsis. Furthermore, a recent paper has suggested that frequent applications of PMX would be effective against severe sepsis 10) . The appropriate duration and frequency of PMX administration for treatment remain unknown.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Necrotizing Fasciitis and Toxic Shock Syndrome by Hip Amputation and Endotoxin Hemoadsorption

et al. 2009

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Background: Necrotizing fasciitis is a rare but severe condition associated with high mortality. We encountered a patient with severe and rapidly progressing necrotizing fasciitis. Patient: A 40-year-old male was hit by a tractor and received a wide laceration wound spanning the length of his posterior thigh. Soon after the accident, the wound was washed and debridement was performed. Two days postoperatively, we observed septic changes in the wound and diagnosed this condition as necrotizing fasciitis. Consequently, the patient's leg was amputated at the thigh. The patient, however, developed toxic shock syndrome after the amputation. Endotoxin adsorption using a polymyxin Bimmobilized fiber column was performed for 2 days. Finally, a hip joint amputation was performed after 11 days, following which the patient's general condition gradually improved. Discussion: Treatment for necrotizing fasciitis should be initiated promptly. Early debridement is associated with a significant decrease in mortality. In severe conditions, endotoxin and cytokine removal by blood purification is one of the most effective treatments. Although group A streptococci are widely known as "flesh-eating bacteria," we should also consider a wide variety of pathogenic organisms to be the probable cause of severe necrotizing fasciitis. Conclusion: Management of necrotizing fasciitis requires careful investigation as well as an aggressive therapeutic approach, which may include urgent surgical intervention. In addition to surgery, endotoxin adsorption therapy should be considered.

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Rapidly Progressive Interstitial Pneumonia Associated with Clinically Amyopathic Dermatomyositis Successfully Treated with Polymyxin B-immobilized Fiber Column Hemoperfusion

Cited by 30 publications

References 28 publications

Gene expression analysis for pneumonia caused by Gram-positive bacterial infection

Gene expression analysis for pneumonia caused by Gram-positive bacterial infection

Rapidly Progressive Interstitial Lung Disease Associated with Dermatomyositis Treated with Combination of Immunosuppressive Therapy, Direct Hemoperfusion with a Polymyxin B Immobilized Fiber Column and Intravenous Immunoglobulin

Successful Treatment of Necrotizing Fasciitis and Toxic Shock Syndrome by Hip Amputation and Endotoxin Hemoadsorption

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