A life-saving case with CAH-CHDF and PMX-DHP for ANCA-associated vasculitis-induced 
ARDS developed after COVID-19 infection

Abstract

A 79-year-old woman presenting gastrointestinal symptoms, which began one week prior, was admitted to the hospital. Initially, antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis triggered by a severe acute respiratory syndrome coronavirus 2 infection was suspected. Upon admission, she experienced severe acute renal failure, followed by the development of acute respiratory distress syndrome, necessitating artificial respirator management and treatment involving cytokine adsorbing hemofilter continuous hemodiafiltration (CAH-CHDF) intermittently using PMMA membrane and direct hemoperfusion with polymyxin B immobilized fiber (PMX-DHP) to adsorb cytokines for circulatory and respiratory failure, leading to improvement. On day 5 of hospitalization, a positive ANCA result prompted the initiation of half-pulse steroid therapy. On day 9, an HCU staff member tested positive for coronavirus disease 2019 (COVID-19), and upon retesting, the patient’s PCR test was also positive. As our hospital policy does not permit the treatment of patients with COVID-19 requiring intubation management, she was transferred to a university hospital in an intubated state. Despite being intubated-extubated three times, she returned to our hospital’s nursing care ward 4 months later in a wheelchair, having undergone tracheostomy and maintenance hemodialysis.