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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; epub

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.

(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 2016; epub

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.