Streptococcus pneumoniae meningitis treated successfully with polymyxin B-immobilized fiber therapy: a case report

Abstract

A-61-year old man was admitted to our hospital with fever and severe disturbance of consciousness. He was diagnosed with Streptococcus pneumoniae meningitis on the basis of cerebrospinal fluid (CSF) analysis and urinary antigen detection by immunochromatography. Although he was treated with dexamethasone and antibiotics, his general status worsened as systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), and status epileptics developed. Following treatment with polymyxin B-immobilized fiber therapy (PMX), which can also absorb bacteria-derived toxic substances, he recovered from DIC and SIRS, and disturbance of consciousness improved immediately. In addition, the concentration of several CSF cytokines--IL-1, IL-2, and TNF-α--was decreased. The present case suggests that PMX is a good option for severe bacterial meningitis.

Clinical effects of polymyxin B‐immobilized fiber column direct hemoperfusion for severe bacterial meningitis: A series of 10 cases

“…Clinical experience with PMX‐DHP for meningitis is limited though and has not been described in English‐language publications. Indeed, our first such case (case 1 in the present study) was reported in Japanese in 2013 …”

“…A 61‐year‐old man presented with impaired consciousness with a GCS score of 5 (E1V1M3), SIRS (temperature, 39.6°C; leukocytes, 5800 cells/μL; pulse rate, 110/min; respiratory rate, 48/min), and elevated C‐reactive protein (8.12 mg/dL) . CSF pressure was elevated at ≥625 mmH 2 O; analysis revealed pleocytosis with 480 cells/μL (78% multinuclear cells) and elevated protein at 536 mg/dL with low glucose (CSF:blood glucose ratio 0.011).…”

“…Alternative treatment was urgently required to maintain life. On hospital day 3, we decided to perform PMX‐DHP to suppress the cytokine storm (Figure ; reprinted from Suzuki et al based on the reported effectiveness of PMX‐DHP for sepsis due to Gram‐positive bacteria . Immediately after the first PMX‐DHP session, he opened his eyes spontaneously and his consciousness level dramatically improved (Figure ).…”