Tang ZQ, Zhao DP, Dong AJ, Li HB. Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function: A case report. World J Clin Cases 2023; 11(27): 6515-6522 [PMID: 37900233 DOI: 10.12998/wjcc.v11.i27.6515]
Corresponding Author of This Article
Hai-Bo Li, PhD, Doctor, Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150001, Heilongjiang Province, China. mzkicu@126.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Sep 26, 2023; 11(27): 6515-6522 Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6515
Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function: A case report
Zhi-Qiang Tang, Dan-Ping Zhao, A-Jing Dong, Hai-Bo Li
Zhi-Qiang Tang, Dan-Ping Zhao, A-Jing Dong, Hai-Bo Li, Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
Author contributions: Tang ZQ and Zhao DP contributed to manuscript writing, editing and data collection; Zhao DP contributed to data analysis; Dong AJ contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai-Bo Li, PhD, Doctor, Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin 150001, Heilongjiang Province, China. mzkicu@126.com
Received: May 31, 2023 Peer-review started: May 31, 2023 First decision: July 17, 2023 Revised: August 6, 2023 Accepted: August 23, 2023 Article in press: August 23, 2023 Published online: September 26, 2023
Abstract
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 °C. 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+) T-cells 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.
Core Tip: Non-liquefied multiple liver abscesses (NMLA) can lead to sepsis, septic shock, and sepsis-associated kidney injury (SA-AKI). Early treatment with continuous renal replacement therapy (CRRT) and hemoperfusion (HP) is particularly important when the patient is not a candidate for ultrasound-guided drainage or surgical intervention. The combination of CRRT and HP is used to control infections, reduce inflammation, and promote T-cell function. This case highlights the importance of holistic treatment in managing septic shock and SA-AKI caused by NMLA and the potential benefits of timely CRRT and HP therapy.
