症状の軽快にもかかわらず(1→3)-β-D-glucan の異常高値が持続した真菌性敗血症の1症例

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A 71-year-old female who showed markedly high serum (1→3)-β-D-glucan level during and after septic shock is reported. The patient presented septic shock 10 days after low anterior resection for rectal cancer. The level of her serum (1→3)-β-D-glucan was elevated to 5, 220pg·ml-1 and Candida albicans was isolated from her blood culture. In spite of full circulatory support with inotropes, she lost renal function and continuous hemodiafiltration (CHDF) was induced. The patient recovered from septic shock and was weaned from mechanical ventilation by means of two weeks intensive care including circulatory support, CHDF and antifungal agents. She remained renal failure and therefore has undergone hemodialysis. Concentration of serum (1→3)-β-D-glucan was in very high (500-1, 000pg·ml-1) level from ICU admission onward even when she recovered and left ICU. Other reasons of high β-D-glucan like cellulose membrane of a dialyser, parenteral nutrient or drugs are hardly possible. The best effort was made to detect focus of fungal infection but not successful and we speculate that deep mycosis lurked silently.
一般社団法人日本集中治療医学会の論文
2003-07-01