Ruiz-Rodríguez Juan Carlos, Chiscano-Camón Luis, Ruiz-Sanmartin Adolf, Palmada Clara, Bajaña Ivan, Iacoboni Gloria, Bonilla Camilo, García-Roche Alejandra, Paola Plata-Menchaca Erika, Maldonado Carolina, Pérez-Carrasco Marcos, Martinez-Gallo Mónica, Franco-Jarava Clara, Hernández-González Manuel, Ferrer Ricard
Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
Front Med (Lausanne). 2022 Aug 15;9:925751. doi: 10.3389/fmed.2022.925751. eCollection 2022.
We discuss a single case of Hemophagocytic lymphohistiocytosis (HLH) due to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation with multiorgan dysfunction and distributive shock in which we performed cytokine hemoadsorption with Cytosorb . A full microbiological panel was carried out, including screening for imported disease, standard serologies and cultures for bacterial and fungal infection. A liver biopsy and bone marrow aspirate were performed, confirming the diagnosis. The patients fulfilled the HLH-2004 diagnostic criteria, and according to the 2018 Consensus Statements by the HLH Steering Committee of the Histiocyte Society, dexamethasone and etoposide were started. There was an associated hypercytokinemia and, due to refractory distributive shock, rescue therapy with cytokine hemoadsorption was performed during 24 h (within day 2 and 3 from ICU admission). After starting this procedure, rapid hemodynamic control was achieved with a significant reduction in vasopressor support requirements. This case report highlights that cytokine hemoadsorption can be an effective since rapid decrease in IL-10 levels and a significant hemodynamic improvement was achieved.
我们讨论了一例因自然杀伤（NK）细胞型非霍奇金淋巴瘤和爱泼斯坦-巴尔病毒再激活导致噬血细胞性淋巴组织细胞增生症（HLH）并伴有多器官功能障碍和分布性休克的病例，我们使用Cytosorb进行了细胞因子血液吸附治疗。进行了全面的微生物检查，包括输入性疾病筛查、细菌和真菌感染的标准血清学检查及培养。进行了肝脏活检和骨髓穿刺，确诊了病情。该患者符合HLH-2004诊断标准，根据组织细胞协会HLH指导委员会2018年的共识声明，开始使用地塞米松和依托泊苷治疗。存在相关的高细胞因子血症，由于难治性分布性休克，在24小时内（从入住重症监护病房的第2天至第3天）进行了细胞因子血液吸附抢救治疗。开始该治疗后，实现了快速的血流动力学控制，血管升压药支持需求显著降低。本病例报告强调，细胞因子血液吸附可能是有效的，因为实现了白细胞介素-10水平的快速下降和显著的血流动力学改善。
