Abstract
BACKGROUND/AIM: The management of Stage II empyema complicated by chronic inflammatory demyelinating polyneuropathy (CIDP) presents a formidable clinical challenge due to the precarious balance required between aggressive infection control and the modulation of immune-mediated neurological frailty. We report a complex case of comorbid empyema and CIDP successfully managed with a multidisciplinary approach and adjuvant molecular hydrogen (H(2)) therapy. CASE REPORT: A 76-year-old male with CIDP presented with acute respiratory failure secondary to Stage II empyema. Following video-assisted thoracoscopic surgery (VATS) decortication, the patient exhibited systemic hyperinflammation and immune exhaustion. Adjuvant oral molecular hydrogen therapy was initiated during the critical phase. Longitudinal immunophenotyping was performed to monitor the therapeutic response. Clinical recovery coincided with profound immunological remodeling. We observed a cell-specific up-regulation of fas cell surface death receptor (Fas) expression in hyper-activated naïve and effector cytotoxic T cells (Tc), suggesting a H(2)-facilitated apoptotic clearance of pro-inflammatory lineages. Conversely, the helper T-cell (Th) reservoir was preserved. Recovery was further characterized by the consistent restoration of intermediate and post-germinal center memory B-cell populations, coupled with a substantial augmentation of suppressive T and B-cell subsets (Tregs and Bregs). This shift toward immune homeostasis prevented secondary autoimmune flares and facilitated successful discharge. CONCLUSION: Molecular hydrogen may act as a systemic bioregulator that fosters immune homeostasis by selectively targeting hyper-activated effector cells while promoting regulatory cell recovery. This dual antioxidant and immunomodulatory capacity positions H(2) as a promising adjuvant therapy for complex infectious and neuroinflammatory conditions.