Multiple organ dysfunction syndrome induced by whole body hyperthermia and polychemotherapy in a patient with disseminated leiomyosarcoma of the uterus

Objective: Whole body hyperthermia (WBH) in combination with chemotherapy is a relatively new promising treatment modality for patients with cancer. The objective of this report is to present the development of an acute systemic inflammatory response syndrome (SIRS) with multiple organ dysfunction syndrome (MODS) following WBH in combination with chemotherapy. Although WBH can also induce cytokine production, MODS has not been described before in association with WBH. Design: Case report. The patient was treated with WBH (core temperature 41.8 degrees C using a radiant heat device (Aquatherm)) in combination with polychemotherapy (ifosfamide, carboplatin and etoposide (ICE)) in the context of a clinical trial for metastatic sarcomas. Setting: Department of Medical Oncology and Intensive Care Unit of a university hospital. Patient: A 58-year-old Caucasian woman treated for disseminated leiomyosarcoma of the uterus, who developed SIRS with brain dysfunction, hypotension, respiratory failure and renal dysfunction following WBH/ICE, Interventions: She was successfully treated in the Intensive Care Unit by mechanical ventilation, inotropics and antibiotics. Measurements and results: There was a remarkable recovery within 2 days: she regained full conciousness, could be extubated, inotropic support was stopped and creatinine levels returned to pre-treatment levels. All cultures remained sterile. After almost complete recovery, 5 days later a second episode of fever during neutropenia occurred and, despite antibiotic treatment, she died of Bacteroides distasonis sepsis. Conclusion: WBH should be added as a new cause to the already known list of physical-chemical insults which can result in MODS.