• Y-T Lee, J Wei, Y-C Chuang, C-Y Chang, I-C Chen, C-F Weng, and G W Schmid-Schönbein.
• Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
• Transplant. Proc. 2012 Apr 1; 44 (3): 817-9.

ObjectiveThe mortality rate among patients with septic shock is high despite current therapy. We present a case of Fournier's gangrene and septic shock at 4 years post-heart transplantation that was reversed by "continuous enteral feeding" of the digestive enzyme inhibitor, gabexate mesilate. Recently, powerful pancreatic digestive proteases in the lumen of the intestine have been identified as initiators of the systemic inflammatory response. Intraluminal inhibitions of the proteases significantly attenuates intestinal damage, system inflammation, and multiorgan failure in experimental forms of shock but it has not been tested in man.Methods And ResultsGabexate mesilate, a synthetic digestive protease inhibitor, was continuously administered in two liters of crystalloid solution to a patient by enteral feeding during septic shock. The condition and markers for shock due to sepsis reversed in a few days.ConclusionThis case suggested that "enteral" digestive protease inhibition may decrease and even reverse the sequelae of shock and sepsis.Copyright © 2012 Elsevier Inc. All rights reserved.

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