Anna Wojtacha, Włodzimierz Samborski, Jacek Juszczyk
CaseRepClinPractRev 2002; 3(1):28-30
Background: Systemic Inflammatory Response Syndrome (SIRS) is the response to an infectious factor or an non-infectious one, which differs this syndrome from sepsis. SIRS is diagnosed if 2 or more of the following criteria
are met: temperature higher than 38°C or lower than 36°C; heart rate higher than 90 beats per minute; respiratory rate higher than 20/min or PaCO2 lower than 32 mmHg; white blood cell count greater than 12 G/l or
less than 4 G/l or the presence of more than 10 immature bands. Multiorgan failure, and often death, result from uncontrolled activation of the cascade of cellular and humoral mediators.
Case report: The case of SIRS in an 18-year-old female patient is described. During the 4 weeks preceding the onset of the first symptoms, the patient was receiving autovaccination against Staphylococcus aureus. The vaccination was done due to the culture from the throat smear. She received the last dose 3 days before the first symptoms. The onset of the disease was connected with high fever and hemorrhagic rush. After 24 hours, she
developed shock with renal failure and syncope. After the next 2 days, gonarthritis was observed. The cultures of blood, urine, throat smear and arthritic liquid were negative. She recovered after treatment with small doses of steroids. It is the first described case of Systemic Inflammatory Response Syndrome after autovaccination.
Conclusions: 1. As a result of administration of a subsequent dose of autovaccine, release of inflammatory mediators was induced in the patient with consequent multiorgan function impairment. 2. The course of the disease
was very rapid and dramatic, requiring immediate institution of abti-shock therapy. 3. SIRS is a syndrome characterized by clinical presentation identical with sepsis. Differential diagnostics is very important because of
different management of these two entities.
Correspondence address: Anna Wojtacha, Clinic of Infectious Diseases,
Medical University of Poznaƒ, ul. Wincentego 2, 61-003 Poznaƒ, Poland
Keywords: Shock, DIC, SIRS