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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
Rivista di Medicina Interna e Farmacologia
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 April;159(2):65-9
Toxoplasmic septic shock, hepatitis, AIDS and thalidomide
Barbosa Vosgerau J. C.
Centro Municipal de Especialidades, Secretariat of Health from Ponta Grossa
Septic shock is a life-threatening condition usually attributed to bacteria, mainly gram negative, whose management often requires intensive care units, and focuses on hemodynamics, respiratory support and antibiotics which are considered critical for controlling DIC. Nevertheless prostaglandins, leukotriens and other ecosanoids and more recently TNF-α and IFN-γ have been shown to play a central role in septic shock pathophysiology, but a drug to control such increased cytokines has not been used until now. Thalidomide has a suppressive effect on TNF-α and probably on IFN-γ. A very ill AIDS patient is reported with gallblader and bilateral kidney stones, cerebral toxoplasmosis, tuberculosis that developed HIV infection reactional state (hepatitis, thrombocytopenic purpura, severe diarrhea, oroesophageal candidiasis, arthralgia, acute congestive heart failure, peripheral neuropathy, seizure, anemia, leukopenia, eosinophilia, lymphocytosis, neutrophilia/neutropenia, increased PT, increased IgG, IgE and circulating immune complexes) and toxoplasmic septic shock unresponsive to usual measures that remitted with thalidomide 3.3 g/day as well as the other disorders, without the intensive care unity. This clinical and laboratory improvement was associate with IgG, IgE IgA decrease of 900, 1272 and 183 mg, respectively. It is postulated that IFN-γ plays a central role in the development of these disorders directly and indirectly by inducing/increasing other cytokines such as TNF-α and IFN-α, triggered by HIV and reinforced by opportunistic infections such as tuberculosis and mainly toxoplasmosis. It was concluded that hepatitis, seizure, acute congestive heart failure are acute life-threatening conditions of HIV infection reactional state or better, of “cytokines storm”, certainly triggered mainly by Toxo-plasma.