Sindromul disfuncţiei multiple de organe (MODS) consecinţa insuficienţei imunitare severe acute secundare

Abstract

Caz clinic. Pacienta G. 21 ani,în stare gravă, obnubilată, astenie marcată, dispnee, tahipnee (frecvenţa respiratorie 30-35r/min), tahicardie sinusală 140b/min., febră (39,5oC), cefalee, artralgii, eritem facial, mialgii, se internează în Clinica ATI a Spitalului Clinic Republican. Debutul bolii insidios, cu 6 luni in urmă cu dispnee inspiratorie, s-a stabilit bronșită acută, a urmat terapia cu antibiotice, alprazolam, omega3, cardiomagnil - fără succes. Monitorizare: TAS, TAD, TAM, FCC, PVC, CT pulmonar, echilibrul electrolitic şi acido-bazic, SO2, CaO2, CvO2, DO2, VO2, ERO2, pH gap, CO2 gap, coagulograma, analize biologice, markerii autoimuni, profilul autoimun prin imunofenotipare, parametrii metabolismului energetic. Diagnosticul instalat: Pneumonită acuta totală, MODS: ARDS, sindrom de CID (tombocitopenie severă), insuficienţă imunitară secundară severă acută (hipercrioglobulinemie severă, - 130 OE, Anti-ds-DNA 22,4 U/ ml (N 0-20.0 U/ml); A-anti-LKMI IgG 43,9 U/ml (N 0-25.0 U/ml); OMMA 47,1 U/ml (N 1-21.0 U/ml); BRMA > 300 (N 9,20-38,0 U/ml); GIMA 23,3 (N 2,50-18,4U/ml),coeficientul imunoreglator 1,7), sindrom anemic. Tratament: Metilprednizolon 500 mg/zi, terapie eferentă (plasmafereză), echilibrarea volemică, electrolitică şi fluido-coagulantă, terapie antiulceroasă preventivă, antispastice, antihistaminice, anticoagulante, vitaminoterapie, diuretice. La a 10 zi pacienta transferată în secţia de profil. Concluzie. Carenţa imunitară secundară în situaţiile critice, este consecinţa directă a dezechilibrului dintre componentele sistemului imunitar, ca urmare a pierderii segmentului regulator, producând dezintegrarea unităţii homeostazice, clinic, manifestându-se în final prin MODS.

Case report. Patient G. 21 years, in critical condition, dizziness, marked asthenia, dyspnea, tachypnea (respiratory rate of 30-35 r / min), sinus tachycardia 140 b / min., fever (39.5°C), headache, arthralgia, flushing, myalgia, is hospitalized in the ICU of the Republican Clinical Hospital. Insidious disease onset of 6 months ago, with clinical sign of inspiratory dyspnea; it was established the diagnosis of acute bronchitis, was instituted antibiotic therapy; alprazolam; omega3; cardiomagnil - which didn't show any success. Monitoring: sBP, dBP, mBP (invasive), CVP, acid-base, gas (peripheral artery and vein, jugular bulb) and electrolytic balances,SO2, CaO2, CvO2, DO2, VO2, ERO2, pH gap, CO2 gap, coagulogram, bioassays, autoimmune markers, autoimmune profile by immunophenotyping, parameters of energetic metabolism. Diagnosis: Acute total pneumonitis; MODS: ARDS, IDC syndrome (severe tombocytopenia), acute severe secondary immune deficiency (severe hipercryoglobulinemia - OE 130, Anti-ds-DNA 22.4 U / ml (0-20.0 N U / ml) A-IgG anti-LKMI 43.9 U / ml (0-25.0 N U / ml) OMMA 47.1 U / ml (1-21.0 N U / ml), BR-MA> 300 (N 9, 20 to 38.0 U / ml), GIMA 23.3 (N 2,50-18,4U / ml), immunoregulatory ratio 1.7), anemic syndrome. Treatment: Methylprednisone 500 mg / day, efferent therapy (plasmapheresis), balanced fluids, electrolyte and fluid-coagulant therapy, anti-ulcer preventive therapy, antispasmodics, antihistamines, anticoagulants, vitamin therapy, diuretics. At the tenth day, the patient was transferred to the ward. Conclusion. Secondary immune deficiency in critical situations is a direct result of the imbalance between the components of the immune system due to loss of regulatory segments, producing the disintegration of the homeostasyc unit, clinically manifested by MODS.