Effects of combination therapy with direct hemoperfusion using polymyxin B-immobilized fiber and oral vancomycin on fulminant pseudomembranous colitis with septic shock.

We report 2 cases of fulminant pseudomembranous colitis with septic shock. The first case showed few symptoms, whereas the second case showed recurrence. Both cases rapidly developed shock and blood pressure was uncontrollable except with the use of pressor agents. Direct hemoperfusion using polymyxin B-immobilized fiber, which was previously demonstrated to have excellent therapeutic effects for the treatment of hypotension in septic shock by removing circulating lipopolysaccharide and oral vancomycin dramatically improved both cases' clinical status and decreased their APACHE II scores (from 18 to 8 and from 16 to 9 points, respectively). Therefore, we suggest that direct hemoperfusion using polymyxin B-immobilized fiber improved hypotension-correcting cytokine balance with adsorption of endogenous cannabinoids in serum. Although colectomy is often performed to treat fulminant pseudomembranous colitis with septic shock, direct hemoperfusion can be easily performed with little risk to the patient. These cases strongly indicated that our combination therapy provides an important treatment for fulminant pseudomembranous colitis with septic shock.