Case Reports other indications

Rescue of cytokine storm due to HLH by hemoadsorption in a CTLA4-deficient patient

Greil C, Roether F, La Rosée P, Grimbacher B, Duerschmied D, Warnatz K
Journal of Clinical Immunology 2017; 37(3):273-6

In this letter to the editor the authors describe the use of a CytoSorb in...

In this letter to the editor the authors describe the use of a CytoSorb in a patient with secondary hemophagocytic lymphohistiocytes (HLH) caused by CTLA-4 deficiency. CTLA-4 deficiency is caused by a heterozygous germ line mutation of the cytotoxic T lymphocytic antigen-4 (CTLA-4) gene leading to a syndrome with prominent features of immune dysregulation. HLH is characterized by fever, splenomegaly, bicytopenia, highly elevated serum levels of ferritin and soluble interleukin-2 receptor (sIL2-R), decreased natural killer (NK) cell activity, hypertriglyceridemia and detection of hemophagocytosis in bone marrow or other tissue. To date, HLH has never been described in a patient with CTLA-4 deficiency. A 50 yr old patient was admitted to ICU with SIRS and multi-organ failure. Despite aggressive intervention his clinical condition rapidly worsened so a CytoSorb adsorber was added into the circuit of the hemodiafiltration. In total 4 adsorbers were used, with columns being changed every 24 hrs. Cytokine adsorption resulted in an immediate decrease in inflammatory parameters, the clinical condition improved in parallel. This suggests the CytoSorb was the decisive therapeutic intervention in this case. The patient was discharged to the regular ward nine days after CytoSorb initiation.

Removal of focal segmental glomerulosclerosis (FSGS) factor suPAR using CytoSorb

Schenk H, Müller-Deile J, Schmitt R, Hinrich Bräsen J, Haller H, Schiffer M.
Journal of Clinical Apheresis 2017; epub

This case looked at the potential therapeutic effect of suPAR elimination (a circulating factor that...

This case looked at the potential therapeutic effect of suPAR elimination (a circulating factor that causes renal failure) in a 32 yr old woman who developed severe post-partum nephrotic syndrome who went on to develop FSGS (focal segmental glomerulosclerosis). After three treatments with total plasma exchange (TPE – the normal method used to remove suPAR) she was given one 8 hour treatment with CytoSorb and the efficiency of both was compared. CytoSorb hemoadsorption caused a 27.33% reduction in the suPAR level in a single treatment, whereas 3 sessions with TPE caused a reduction of 25.12% (P<0.01). The authors conclude that compared to TPE, plasmapheresis, and immunoadsorption, CytoSorb hemoadsorption is an effective novel treatment alternative for removal of circulating factors in patients with idiopathic FSGS or for patients with a recurrence of primary FSGS in the transplanted kidney.

Venlafaxine intoxication with development of takotsubo cardiomyopathy: successful use of extracorporeal life support, intravenous lipid emulsion and CytoSorb.

Schroeder I, Zoller M, Angstwurm M, Kur F, Frey L.
Int J Artif Organs 2017; pub

This case report describes a 19 yr old female who ingested 18g of venlafaxine –...

This case report describes a 19 yr old female who ingested 18g of venlafaxine – 240 times the daily therapeutic dose (a treatment for affective disorders) –  who went on to develop severe takotsubo cardiomyopathy and multi-organ dysfunction syndrome. As there is minimal clearance of the drug with hemodialysis, and there is no specific antidote available, she was treated with intravenous lipid emulsion (ILE) and CytoSorb to enhance detoxification of the drug, and extracorporeal life support as a bridge to support the cardiac failure. Despite the relatively short use of CytoSorb (9 hours), a massive reduction in venlafaxine and its metabolites was observed under the combined therapy with ILE. Over time other therapies including the ECLS, ventilation, and dialysis could be withdrawn and the patient went on to make a full recovery.

Pediatric patient with dengue fever and associated multiorgan dysfunction syndrome (MODS) receiving haemoadsorption using CytoSorb – a case report on clinical experience

Mekala N and Damera S
Nephrol Dial Transplant 2017; 32(suppl 3):iii746

In this case report a 10- year old boy with dengue hemorrhagic fever and multi...

In this case report a 10- year old boy with dengue hemorrhagic fever and multi organ dysfunction (including thrombocytopenia, coagulopathy, systemic inflammatory response syndrome, acute fulminant hepatic failure with encephalopathy and oliguria) was treated successfully and safely with a combination of standard care and hemoadsorption with Cytosorb for an 18 hour period. The patient was eventually discharged alive and well.

Cytokine adsorption is a promising tool for therapy of hemophagocytic lymphohistiocytosis (HLH)

Frimmel S, Bogdenow S, Schipper J, Hinz M, Mitzner S, Koball S.
Nephrol Dial Transplant 2017; 32(Suppl_3): SP247

In this case series 2 patients with 3 episodes of severe hemophagocytic lymphohistiocytosis (HLH) are...

In this case series 2 patients with 3 episodes of severe hemophagocytic lymphohistiocytosis (HLH) are treated with Cytosorb. In the first case of a 50 yr old woman with acute necrotizing hepatitis caused by Herpes simplex and HLH, CytoSorb was used to help bridge the time to liver transplant.  In the second case a 42-year-old male patient with respiratory and circulatory failure, septic shock and acute renal failure was treated for 48 hours with 2 CytoSorb adsorbers. After a second relapse he was again treated with CytoSorb and sent on to make a full recovery. In both cases a marked decrease in IL-6 plasma levels, and vasopressor needs were the major results. Importantly, treatment was safe and well- tolerated, without any adverse events.

(The Use of a Cytokine Adsorber (CytoSorb) in a Patient with Septic Shock and Multi-Organ Dysfunction (MODS) after a Severe Burn Injury)

Houschyar KS, Nietzschmann I, Siemers F
Handchir Mikrochir Plast Chir 2017; 49(39:123-6

Article in German only

This case report reports on a 21-year-old patient who was admitted...

Article in German only

This case report reports on a 21-year-old patient who was admitted to hospital immediately following an explosion in the home environment with 2b-3-degree burns of a total of 60% of the body surface area. On the day of admission, he was immediately given bath therapy while he was still hemodynamically stable, with surgical wound treatment of the burned areas. Because of the severity of his burns, multiple operations were performed, with Meek transplants 1: 6 on his lower abdomen, both upper arms, the upper thorax and both forearms. Further therapy consisted of epifascial debridements, keratinocyte deposits and automatic prone / supine positioning. With sustained elevation of the inflammatory parameters (leukocytes, C-reactive protein and procalcitonin) and renal function, positive blood cultures and wound smears for Acinetobacter baumannii, the decision was made to start hemofiltration therapy with additional CytoSorb adsorbers to induce a reduction in these parameters. The CytoSorb adsorber was used daily from the 9th – 17th treatment days and from days 32 – 52. The interleukins IL-6 and IL-10 were significantly reduced during the treatment, the catecholamine requirement was significantly reduced and circulatory stabilization could be achieved. Due to cardiopulmonary insufficiency in the context of a multiorgan failure, the patient died on the 52nd postoperative day.

A clinical experience of using extracorporeal cytokine adsorption device (CytoSorb) in a case of Dengue fever

Khan, Z.A.
J Evid. Based Med. Healthc., 3(87): 4779 - 81

This case study reports on a patient with Dengue fever, septic shock and multiple organ...

This case study reports on a patient with Dengue fever, septic shock and multiple organ failure (MOF). Dengue is a mosquito-borne viral disease where it is thought that elevated cytokines (tumour necrosis factor alpha – TNF-α, interleukins and interferon gamma – IFN-γ) cause damage to the endothelial cells of the capillaries that results in fluid leakage. Here a 32 year old male patient was admitted to the intensive care unit and because of multiple organ failure, he was mechanically ventilated and put on renal replacement therapy. CytoSorb was used as an adjuvant supportive therapy on days 2, 4 and 6 of admission. The patient also received multiple transfusions to address thrombocytopenia and coagulopathy. The patient showed gradual improvement with a normalization of the central nervous system, improved oxygenation status, adequate renal function and normal platelet count (APACHE score 27 before and 12 at the end of CytoSorb treatment). Liver function also improved significantly. Serum Glutamic Oxaloacetic Transaminase – GOT (AST) fell from 15,690 U/L to 156 U/L, and Serum Glutamic Pyretic Transaminase – GPT (ALT) fell from 3910 to 84 after CytoSorb treatment). The patient was discharged from ICU on day 13 and subsequently discharged. The authors note that CytoSorb® seems to be a useful and safe extracorporeal therapy option to stabilize and help dengue shock patients with MODS to recover.

Case report of 1 Patient with multiorgan failure due to severe SIRS in cardiac failure treated additional with Cytosorbents haemadsorption as adjunctive therapy

Kogelmann K, Drüner M, Jarczak D
Infection. 2015 Aug;43Suppl 1:1-73. Abstract No. 126

This case study reports on a patient with severe SIRS and multiple organ failure in...

This case study reports on a patient with severe SIRS and multiple organ failure in cardiogenic shock due to refractory cardiac arrhythmia, diffuse hypokinesia and an ejection fraction of~45 % with a heart rate of 36 bpm. After 24 hours of conventional treatment, CytoSorb therapy and CRRT was initiated due to high and stable catecholamine support associated with a persistent renal failure.During CytoSorb therapy the authors found a decrease in catecholamine demand of more than 95 % and 72 h after therapy the patient had been free of catecholamines.SOFA Score did not change while SAPS II-Score decreased to 50% of its initial value. Blood lactate, creatinine and liver enzymes decreased markedly and normalised after 2 weeks. Treatment using CytoSorb adsorption in this patient had shown great effect, been safe and without any noticed side effects. The authors note that CytoSorb therapy was helpful even in a patient with severe cardiac failure and thereby initiated severe SIRS.