Detection of Plasma Endotoxin Using a Novel Rapid Limulus Amoebocyte Lysate Assay in a Patient with Sepsis Caused by Colorectal Perforation During Tocilizumab Treatment

Endotoxin appears to play a major role in the development of toxic symptoms in sepsis. The turbidimetric Limulus amoebocyte lysate (LAL) assay is usually used for the detection of endotoxin ; however, a novel rapid LAL assay for endotoxin has recently been developed that uses a laser light–scattering particle–counting method, called endotoxin scattering photometry (ESP). We report a case of sepsis in a patient with colorectal perforation, in which plasma endotoxin was detected by the ESP but not by turbidimetry. A 70–year–old woman with severe abdominal pain who received tocilizumab, an interleukin–6 receptor antagonist, was diagnosed with diffuse peritonitis caused by intestinal perforation. Emergency surgery revealed perforation of a rectosigmoid diverticulum, and the patient underwent Hartmann′s procedure. She presented with sepsis after surgery ; however, her overall condition rapidly improved. Decreased plasma endotoxin measured by EPS and reduction in plasma interleukin–6 appeared to accompany her improved septic condition. In conclusion, we experienced a successfully treated case of sepsis caused by colorectal perforation, despite tocilizumab administration. Moreover, ESP may more sensitively detect sepsis than the widely–used quantitative turbidimetric endotoxin assay.