Home > Journals > Gazzetta Medica Italiana Archivio per le Scienze Mediche > Past Issues > Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 April;159(2) > Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 April;159(2):65-9

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Reprints
Permissions
Share

 

CLINICAL CASES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2000 April;159(2):65-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Toxoplasmic septic shock, hepatitis, AIDS and thalidomide

Barbosa Vosgerau J. C.

Centro Municipal de Especialidades, Secretariat of Health from Ponta Grossa


PDF


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.

top of page