Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function:A case report

BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.

Multiple skin abscesses associated with bacteremia caused by Burkholderia gladioli:A case report

BACKGROUND Burkholderia gladioli(B.gladioli)is regarded as a rare opportunistic pathogen.Only a few patients with abscesses caused by B.gladioli infections have been reported,and these are usually abscesses at the incision caused by traumatic surgery.CASE SUMMARY A 74-year-old male patient with abscesses and pain throughout his body for 1 mo was admitted to our hospital.Some of the abscesses had ruptured with purulent secretions on admission.Color Doppler ultrasound examination of the body surface masses showed mixed masses 75 mm×19 mm,58 mm×17 mm,17 mm×7 mm,and 33 mm×17 mm in size in the muscle tissues of both the right and left forearms,the posterior area of the right knee and the left leg,respectively.Abscess secretions and blood cultures grew B.gladioli.The following 3 methods were used to jointly identify the bacterium:an automatic microbial identification system,matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,and full-length 16 S rDNA sequencing.After 27 d of treatment with meropenem,etimicin,trimethoprim-sulfamethoxazole and other antibiotics,most of his skin abscesses were flat and he was discharged without any symptoms.CONCLUSION This is the first reported case of multiple skin abscesses associated with bacteremia caused by B.gladioli.Our study provides important reference values for the clinical diagnosis and treatment of B.gladioli infections.

Surgery and antibiotics for the treatment of lupus nephritis with cerebral abscesses:A case report

BACKGROUND Systemic lupus erythematosus(SLE)patients are extremely susceptible to opportunistic infections due to glucocorticoid and immunosuppressive treatments,which often occur in the respiratory system,the urinary system and the skin.However,multiple cerebral infections are rarely reported and their treatment is not standardized,especially when induced by a rare pathogen.CASE SUMMARY A 46-year-old woman was treated with glucocorticoid and immunosuppressant for SLE involving the hematologic system and kidneys(class IV-G lupus nephritis)for more than one year.She was admitted to hospital due to headache and fever,and was diagnosed with multiple cerebral abscesses.Brain enhanced magnetic resonance imaging showed multiple nodular abnormal signals in both frontal lobes,left parietal and temporal lobes,left masseteric space(left temporalis and masseter region).The initial surgical plan was only to remove the large abscesses in the left parietal lobe and right frontal lobe.After surgery,based on the drug susceptibility test results(a rare pathogen Nocardia asteroides was found)and taking into consideration the patient’s renal dysfunction,a multi-antibiotic regimen was selected for the treatment.The immunosuppressant mycophenolate mofetil was discontinued on admission and the dose of prednisone was reduced from 20 mg/d to 10 mg/d.Re-examination at 3 mo post-surgery showed that the intracranial lesions were reduced,the edema around the lesions was absorbed and dissipated,and her neurological symptoms had disappeared.The patient had no headaches or other neurological symptoms and lupus nephritis was stable during the 2-year follow-up period.CONCLUSION In this report,we provide reasonable indications for immunosuppression,anti-infective therapy and individualized surgery for an SLE patient complicated with multiple cerebral abscesses caused by a rare pathogen,which may help improve the diagnosis and treatment of similar cases.