Sepsis like a severe complication of autoimmune liver disease in gastroenterological patients

Abstract

In the article, we present features of clinical pattern and treatment of patients with ulcerative colitis associated with primary sclerosing cholangitis and autoimmune hepatitis. Course of disease was complicated by bacterial cholangitis, sepsis, and multiple organ failure. Pathogenetic features of autoimmune disorder in liver and bowel diseases are described. The role of bacterial translocation in primary immune disorder development and in inflammatory syndrome maintenance is described. Differential diagnosis challenges in primary and secondary cholangitis are described. Features of management of patients in critical condition are reviewed in the article. The role of glucocorticosteroids in sepsis treatment is sketched. Modern guidelines for the management of patients with overlap syndrome are highlighted. Patient D. was admitted to the intensive care unit of the hospital with a clinical pattern of shock and systemic inflammatory response syndrome. Exacerbation of ulcerative colitis complicated by infection on the background of primary sclerosing cholangitis and autoimmune hepatitis was diagnosed. This condition led to sepsis and multiple organ failure. Despite intensive care treatment, there was a progressive worsening of the patient's state until clinical death. Resuscitation procedures within 6 minutes were successful. Multiple areas of necrosis have developed on the limbs because of multiple organ failure and intensive treatment with vasopressors. Glucocorticosteroids in combination with antibacterial agents were prescribed despite sepsis with ulcerative colitis exacerbation and cytolysis syndrome. On the thirtieth day of hospital stay, patient D. was transferred from the intensive care unit to the gastroenterology department, where the treatment was continued. Because of the treatment provided, signs of multiple organ failure, infectious complications, exacerbation of ulcerative colitis and primary sclerosing cholangitis regressed. The patient was regularly followed-up.Copyright © 2020 American Physiological Society. All rights reserved.