Berkes Andrea, Szikszay Edit, Kappelmayer János, Kerényi Adrienne, Szabó Tamás, Ujhelyi László, Bari Krisztina, Balla György, Balla József
Department of Pediatrics, University of Debrecen, Debrecen 4012, Hungary.
Institute of Laboratory Medicine, University of Debrecen, Debrecen 4012, Hungary.
Case Rep Crit Care. 2017;2017:3818407. doi: 10.1155/2017/3818407. Epub 2017 Jul 16.
Toxic shock syndrome is a potentially fatal toxin-mediated disease. The role of toxins in this clinical entity made us hypothesize that extracorporeal blood purification with CytoSorb® could play a beneficial role in the clinical management of toxic shock syndrome. This case report describes the successful treatment of toxic shock syndrome using a combination of renal replacement therapy and hemadsorption in a pediatric patient.
A 5-year-old girl with Down's syndrome presented with an inflamed area surrounding an insect bite, signs of systemic inflammation, and multiple organ failure. As previous attempts of immune modulation therapy were unsuccessful, renal replacement therapy was supplemented by the cytokine absorber CytoSorb. Treatment using this combination was associated with a rapid and significant stabilization in the hemodynamic situation and a decrease in inflammatory mediators within hours after the initiation of therapy. The application of CytoSorb therapy was simple and safe.
The use of extracorporeal blood purification with CytoSorb proved potentially beneficial by removing toxins and inflammatory mediators in this case and could therefore play a role in the clinical management of toxic shock syndrome. Whether CytoSorb has the potential to even positively influence mortality in patients with toxic shock syndrome still needs to be confirmed.
中毒性休克综合征是一种潜在致命的毒素介导疾病。鉴于毒素在该临床病症中的作用,我们推测使用CytoSorb®进行体外血液净化可能在中毒性休克综合征的临床治疗中发挥有益作用。本病例报告描述了一名儿科患者采用肾脏替代疗法和血液吸附联合治疗中毒性休克综合征的成功案例。
一名患有唐氏综合征的5岁女孩,出现昆虫叮咬周围区域发炎、全身炎症体征及多器官功能衰竭。由于先前的免疫调节治疗尝试未成功,故在肾脏替代治疗基础上补充细胞因子吸附器CytoSorb。采用这种联合治疗后,在治疗开始数小时内,血流动力学状况迅速且显著稳定,炎症介质减少。CytoSorb治疗的应用简单且安全。
在本病例中,使用CytoSorb进行体外血液净化通过清除毒素和炎症介质被证明可能有益,因此可在中毒性休克综合征的临床治疗中发挥作用。CytoSorb是否有潜力对中毒性休克综合征患者的死亡率产生积极影响仍有待证实。