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

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.