We encountered two cases of chronic renal failure expressing pronounced leukocytosis and shock due to pseudomembranous colitis (PMC) requiring endotoxin adsorption using polymyxin-B immobilized fiber (PMX).
Case 1: female, age 81. She received regular outpatient treatments of chronic renal failure. Hemodialysis was introduced when she developed acute bronchitis. We administered cefotiam for seven days, and then, cefazolin for five days to control infection. On this occasion, diarrhea, fever and abdominal discomfort developed. We thought that these symptoms were caused by bacterial enteritis and continued to administer antibiotics. However, the symptoms were not eliminated. Thereafter, she developed pronounced leukocytosis (31, 200/μL) and shock. Although blood pressure was temporarily elevated by PMX, the patient died the following day.
Case 2: female, age 67. She received regular outpatient treatments for diabetes and chronic renal failure. She was administered levofloxacin against fever; however, the symptom was not eliminated. Pronounced leukocytosis (54, 800/μL) and diarrhea were observed and we suspected PMC. We administered a preparation of lactobacillus and followed the course. Since she developed shock, we performed PMX and the hemodynamic state was improved. At a later date, we administered meropenem against catheter fever for four days and she again developed PMC and shock. The second PMX was highly effective. The symptoms did not recur after administering vancomycin.
Pronounced leukocytosis appeared to be a useful sign for diagnosing PMC. It was supposed that PMX was effective for septic shock accompanying PMC and should be performed without delay if the patient is refractory to conservative medical management.