| Abstrakt: |
Background: Surgical trauma may affect immunity and pave the way for septic complications. In our case, the intensive care follow-up of a patient who developed spondylodiscitis and diagnosed with immunodeficiency and ARDS-Sepsis was presented, and the literature was reviewed. Case: A 36-year-old male patient became immobile with severe pain after a lumbar disc hernia repair twenty-eight days ago. Antibiotherapy was started after the diagnosis of Spondylodiscitis by MRI (Figure 1). Due to his clinical deterioration, he was transferred to our intensive care unit with the preliminary diagnosis of ARDS-sepsis and acute renal failure. There were tachycardia, hypotension, hypoxia, anuria, with no infective findings in the operation area. Continuous venovenous hemodialysis and cytokine filter were applied to the patient. The cytokine filter was terminated on the third day with the regression of ARDS and infective parameters (Table 1), and the patient was followed up with high flow (fiO²: 100 flow: 60L/min). Hypoxia became evident on the seventh day, and the patient had to be intubated on the tenth day. Antibiotherapy was expanded due to acinetobacter and hyphae in deep tracheal aspirate. Deepening of thrombocytopenia was thought to be related to antibiotics. IgG level was 569 mg/dL (700-1600 mg/dL). Intravenous Ig (IVIG) was administered. As the cytopenia continued, it was thought that infection-related immune thrombocytopenia might have been added, and IVIG was planned again, the treatment was completed with clinical response. After sixty days of intensive care follow-up, the patient was removed from the intensive care unit by closing the tracheotomy. Conclusion: Spondylodiscitis is usually bacterial and occurs after surgery. Complications, constant source of infection, and prolonged antibiotic therapy may lead to multiple organ dysfunction syndrome (MODS) due to uncompensated excessive and prolonged proinflammatory responses in patients. Long-term hospitalization after surgery, immobility, malnutrition are predisposing factors to sepsis; it also reveals the imbalance of inflammatory and anti-inflammatory processes. Thus, prolonged immunodeficiency findings can be observed. The patient, who developed MODS and secondary immunodeficiency, was discharged after meticulous multidisciplinary follow-up. In conclusion, it should be kept in mind that the immune system may be suppressed in young and low-risk patients and the resulting sepsis may cause multi-organ damage. [ABSTRACT FROM AUTHOR] |
