DISCUSSION
The clinical manifestations of sepsis are highly variable, depending on the initial site of infection, the causative organism, the pattern of acute organ dysfunction, the underlying health status of the patient, and the interval before initiation of treatment[5]. The patient had met the diagnostic criteria of sepsis when admission. He received the examinations of pathogeny of local Centers for Disease Control and our hospital at the time of hospitalization but no tests results were positive. In this case, we mainly provided supportive treatment and antibacterial treatment.
In 1984, Parker et al. first proposed the concept of sepsis induced cardiomyopathy[6]. Recent literature suggests that >10% of patients with sepsis and septic shock develop septic cardiomyopathy. They observed that 65% of patients with septic shock developed left ventricular systolic dysfunction (defined as ejection fraction < 45%). SIC is a reversible myocardial dysfunction caused by sepsis, and can be reversed in 7–10 days. The SIC has been summarized as a global (systolic and diastolic) but reversible dysfunction of both the left and right sides of the heart. More than half of sepsis patients have secondary sepsis cardiomyopathy. The combination of dysregulation of inflammatory mediators, mitochondrial dysfunction, oxidative stress, disorder of calcium regulation, autonomic nervous system dysregulation, and endothelial dysfunction contribute to the complex pathogenesis of SIC[7-10]. In addition to the use of vasoactive drugs, mechanical support with Intra-aortic balloon pumping (IABP) or ECMO seems to be the last option for unresponsive severe cardiogenic shock due to SIC. IABP is used to increase the cardiac output and reduce the dosage of a vasopressor. Consequently, IABP prolongs survival time and lowers vasopressor requirements[11]. ECMO is a life-saving method which is used extensively due to its significant role in providing support in patients with respiratory failure, cardiac failure, or both. It helps via a modified form of cardiopulmonary bypass providing time to rest the patients’ lung[12,13]. There are some studies reported the successful use of V-A ECMO in patients with SIC[1,4]. In our study, the patient used the V-V ECMO treatment due to ARDS. He progressed to SIC during the application of ECMO. Compared with V-A ECMO, patients undergoing V-V ECMO get more stable hemodynamic, and less complications as well. Therefore, the case showed that patient with sepsis and sepsis induced cardiomyopathy could benefit from V-V ECMO.
The patient had fever before admission, but the fever persists even after antibiotics are used. However, the PCT tended to return to normal, indicating that the anti-infection treatment was effective. The eosinophils count substantially increased at the time of hospitalization. And the patient recovered from the fever as soon as moxifloxacin was stopped (Figure 3) . Therefore, the fever was more likely to be caused by drugs. There are many reasons may contribute to the drug-induced fever, and the allergic reaction is the most common one[14]. Therefore, elevated serum total IgE and eosinophil counts are common manifestations of drug fever[14,15]. For patients with persistent high body temperature, we should accurately assess the patient’s condition, timely determine the cause of fever, and provide the most reasonable drug regimen for patients.
In conclusion, we report a patient with severe septic shock and sepsis induced cardiomyopathy who recovered from V-V ECMO and prone position ventilation treatments. The outcome of our patient shows that V-V ECMO may also benefit the patient with less complications when managing septic shock and septic cardiomyopathy.