CYTOKINE PRODUCTION PRECEDES THE EXPANSION OF CD14(- A CASE-REPORT OFA PATIENT WITH SELF-INDUCED SEPTICEMIA()CD16(+) MONOCYTES IN HUMAN SEPSIS )

We describe a patient with self-induced disease who presented with rep eated urinary tract infection and sepsis due to intravesical and intra venous injection of feces. Sepsis occurred repeatedly such that the pa tient exhibited 10 bouts of fever >40 degrees C in a single month. Thi s bacterial challenge led to massive activation of the monocyte system with high levels of TNF-alpha, IL-6, and monocyte colony-stimulating factor (M-CSF). This cytokine response was followed by strong expansio n of the novel CD14(+)CD16(+) monocyte subset. These results suggest t hat cytokines induce the development of CD14(+)CD16(+) cells in human septicemia and that CD14(+)CD16(+) cells may serve as indicator for pr evious bouts of excessive inflammation.