The endotoxin activity assay as a useful guide for the application of polymyxin B hemoperfusion: a case report

The pathophysiology of sepsis is complex and influenced by various host and pathogen-related factors.Endotoxin, a major component of the outer membrane of Gram-negative bacteria, is recognized as a potent pathogen-associated molecular pattern.It activates the complement cascade and initiates host inflammatory responses, potentially leading to endotoxic septic shock (ESS), which is characterized by significant multiple organ failure.Polymyxin B-based direct hemoperfusion (PMX-DHP) is an adjunctive management for septic shock that removes circulating endotoxin through adsorption, thereby improving clinical outcomes by preventing the further progression of inflammation.In this report, we present two cases of ESS.The first case was confirmed by the early detection of Gram-negative bacteria in blood cultures, while the second case was identified through an endotoxin activity assay.Based on these findings, PMX-DHP was promptly administered, resulting in hemodynamic stability and clinical improvement.