Alteration in Plasma Endotoxin Level Measured by Endotoxin Scattering Photometry Method in Two Patients with Septic Shock

Abstract

Abstract We report two cases of septic shock in which plasma endotoxins were detected by a novel endotoxin detection method, named endotoxin scattering photometry (ESP) method. Case1: An 85-year-old female was diagnosed with peritonitis caused by sigmoid colon perforation. The patient presented with septic shock after Hartmann’s procedure. Reduction in the elevated endotoxin levels was observed accompanied with the improvement of hemodynamic condition by standard treatment. A temporal elevation of endotoxin at POD3 was observed by ESP but not by turbidimetric method, relating with a decreased blood pressure and requirement of catecholamine. Case2: Since a 73-year-old man with necrotic pancreatitis presented with septic shock, a direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX) was employed. Plasma endotoxins measured by ESP method were markedly reduced by PMX. This reduction of endotoxin measured by ESP method but not by turbidimetric method was related with the improvement of hemodynamic condition. In conclusion, since the alteration in plasma endotoxin measured by ESP method could be in parallel with the improvement of patient’ s condition, ESP method may be able to sensitively evaluate endotoxins than the widely used ordinary turbidimetric method. Further study needed to clarify the diagnostic significance of ESP method.