Combination therapy with direct hemoperfusion using polymyxin B-immobilized fiber and oral vancomycin improves fulminant pseudomembranous colitis by reducing the elevated endogenous cannabinoids and inflammatory cytokines: report of a case.

Abstract	This paper reports a case of fulminant pseudo-membranous colitis which did not lead to septic shock. The case was improved by combination therapy with direct hemoperfusion using polymyxin B-immobilized fiber and oral vancomycin. Direct hemoperfusion using polymyxin B-immobilized fiber has been demonstrated to have excellent therapeutic effects for the treatment of septic shock by removing circulating lipopolysaccharide. In the present case, the combination therapy dramatically improved clinical status of the patient. The clinical improvement occurred in parallel with a decrease in APACHE II score (from 20 to 14 points), serum levels of endogenous cannabinoids (anandamide and 2-arachidonylglycerol), and inflammatory cytokine (interleukin-6). Thus, direct hemoperfusion is strongly recommended in cases of fulminant pseudomembranous colitis, because direct hemoperfusion using polymyxin B-immobilized fiber reduces inflammatory cytokines by absorbing endogenous cannabinoids and, thereby, improves the patient's condition.
Authors	Yoshihide Kimura, Koichi Sato, Hiroshi Tokuda, Teruto Hashiguchi, Ikuro Maruyama, Etsuro Orito, Yasuaki Dohi, Takashi Joh
Journal	Hepato-gastroenterology (Hepatogastroenterology) 2008 May-Jun Vol. 55 Issue 84 Pg. 956-8 ISSN: 0172-6390 [Print] Greece
PMID	18705306 (Publication Type: Case Reports, Journal Article)
Chemical References	Anti-Bacterial Agents Cannabinoid Receptor Modulators Cytokines Vancomycin Polymyxin B
Topics	APACHE Administration, Oral Aged, 80 and over Anti-Bacterial Agents (administration & dosage) Cannabinoid Receptor Modulators (blood) Clostridioides difficile Clostridium Infections (diagnosis, drug therapy) Colonoscopy Combined Modality Therapy Cytokines (blood) Enterocolitis, Pseudomembranous (diagnosis, drug therapy) Hemoperfusion (methods) Humans Male Polymyxin B (administration & dosage) Sepsis (diagnosis, drug therapy) Vancomycin (administration & dosage)

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