Cytokine production precedes the expansion of CD14(+)CD16(+) monocytes in human sepsis: A case report of a patient with self-induced septicemia

We describe a patient with self-induced disease who presented with repeated urinary tract infection and sepsis due to intravesical and intravenous injection of feces. Sepsis occurred repeatedly such that the patient exhibited 10 bouts of fever >40 degrees C in a single month. This 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 expansion of the novel CD14(+)CD16(+) monocyte subset. These results suggest that cytokines induce the development of CD14(+)CD16(+) cells in human septicemia and that CD14(+)CD16(+) cells may serve as indicator for previous bouts of excessive inflammation.