Excellent response to concomitant use of PMX-DHP and PMMA-CHDF in a hemophagocytic syndrome patient experiencing shock

Abstract

【Patient】The patient was a 63-year-old woman who presented with a fever of 39℃ and diarrheal symptoms for the past 8 days. Infectious enteritis was diagnosed at a nearby clinic where she was hospitalized for routine tests. Thrombocytopenia and hemophagocytic images in the bone marrow were observed. Secondary HPS from bacterial infection was suspected, and she was brought to this hospital to be treated for sepsis and DIC. She experienced septic shock during steroid pulse therapy for HPS. PMMA-CHDF for removing mediators such as cytokines and PMX-DHP for removing and inhibiting other mediators such as endotoxin were administered by a series circuit. From initiation to 24h and 48h, her systolic blood pressure (mmHg) increased (75, 110, and 130, respectively), CAI decreased (11.6, 6.1, and 3.9, respectively), and urine output (mL/h) increased (70, 98, and 120, respectively). Hemodynamics improved rapidly, and the pathological condition of HPS trended towards quiescence. 【Conclusion】Hypercytokinemia was considered the cause of the underlying condition of HPS. Treatment with CHDF and PMX-DHP using a PMMA membrane for the purpose of removing and inhibiting mediators such as cytokines at the onset of secondary HPS caused by bacterial infection was effective.