Successful application of CytoSorb^® hemadsorption in an immunocompromised teenager with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis

Objective: CytoSorb^® hemadsorption is an adjunctive therapy in order to reduce elevated cytokine levels of interleukin-6, interleukin-1, and tumor necrosis factor alpha. Here we present a successful administration of CytoSorb^® hemadsorption in an immunocompromised pediatric patient with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis. Data sources: Clinical observations of one patient. Study selection: Case report. Data extraction: Data sources are clinical observation during patient management and patient’s medical records if needed. The patient’s consent was obtained prior to the study. Data synthesis: A 17-year-old male with diarrhea was admitted to the hospital and was later found to have elevated creatinine levels and proteinuria. The renal biopsy was consistent with collapsing glomerulopathy and treatment with multi immunosuppressive agents including corticosteroids, mycophenolate mofetil, and rituximab coupled with several courses of hemodialysis and plasmapheresis were administered. During the hospital stay, Stenotrophomonas maltophilia bacteremia from the blood and the catheter cultures were identified. No clinical response was achieved, and patient developed severe sepsis despite antibiotics, intravenous immunoglobulin, and supportive management including albumin, platelet and erythrocyte concentrations, and fresh frozen plasma. CytoSorb^® hemadsorption was then added to the ongoing treatment for three consecutive days. Subsequent to CytoSorb^® hemadsorption, immediate laboratory and clinical response were observed. Conclusion: This is the successful clinical report of an immunocompromised teenager with collapsing nephropathy, sepsis, and multi-organ dysfunction syndrome treated with a combination of renal replacement therapy and CytoSorb^® hemadsorption. The usage of CytoSorb^® hemadsorption represents a novel approach to improve survival of the patients with multiple organ dysfunction and sepsis.