Pediatric cases of severe hemophagocytic lymphohistiocytosis improved by continuous hemodiafiltration

Abstract

 Continuous hemodiafiltration was initiated for two children with severe hemophagocytic lymphohistiocytosis (HLH) that was unresponsive to immunosuppressive therapy. Case 1 involved a 6-year-old boy who relapsed into HLH during the course of juvenile idiopathic arthritis. He showed hypotension and renal impairment despite immunosuppressive therapy. Case 2 involved a 14-year-old girl who relapsed into Epstein-Barr virus-associated HLH. She presented with hypotension, renal impairment, and intravascular coagulopathy after treatment with methylprednisolone, cyclosporine, and etoposide. In these 2 cases, symptoms and laboratory abnormalities improved after continuous hemodiafiltration. Continuous hemodiafiltration may be effective for the treatment of children with severe HLH unresponsive to immunosuppressive therapy.