Successful treatment with extracorporeal circulation and chemotherapy for neuroblastoma complicated by cardiac shock and severe renal failure

Abstract

A 2-year-old female presented with acute heart failure and renal failure, and she was started on Extra-corporeal membrane oxygenation (ECMO) and continuous hemodiafiltration (CHDF). ECMO led to improvement in her heart function; however, she developed high blood pressure following ECMO withdrawal. Computed tomography revealed a left adrenal tumor and double renal arteries that were narrowed at their origin. Urinary vanillylmandelic acid and homovanillic acid, as well as serum neuron-specific enolase levels were increased, and I¹²³-metaiodobenzylguanidine (I¹²³-MIBG) scintigraphy revealed I¹²³-MIBG accumulation in the tumor. Blood tests showed high plasma renin and aldosterone levels. Bone marrow aspiration revealed abnormal cells, and she was diagnosed as having neuroblastoma and renovascular hypertension. We concluded that a neuroblastoma concomitant with renovascular hypertension precipitated hypertensive cardiac shock and severe renal failure. Chemotherapy improved hypertension and renal failure. Chemotherapy with ECMO and CHDF are effective rescue strategies in patients with neuroblastoma complicated by severe heart and renal failure.