Effect of corticosteroids on nuclear factor-kappa B activation and hemodynamics in late septic shock

Objective: To describe the underlying pathophysiologic mechanisms of the ef fect of corticosteroids in a patient with late septic shock. Design: Case report. Setting: The medical intensive care unit at University Medical Center Utrec ht. Patient: An 86-yr-old female patient with late septic shock requiring mecha nical ventilation and vasopressive agents. Interventions: Administration of hydrocortisone, 300 mg daily. Measurements and Main Results: Within 3 days of corticosteroid treatment, t he patient could be weaned of vasopressive agents and mechanical ventilatio n, Serum C-reactive protein levels normalized. Nuclear factor-kappaB activa tion in unstimulated and in vitro lipopolysaccharide-stimulated peripheral blood mononuclear cells decreased to background level within 5 days. Repeat ed functional tests of the hypothalamic-pituitary-adrenal axis were normal. Conclusion: Our data suggest that the pathophysiologic mechanism behind the clinical effects of supraphysiologic doses of corticosteroids in late sept ic shock is directly related to the inhibition of nuclear factor-kappaB in peripheral blood mononuclear cells.