CytoSorbents Corporation (CTSO)

[andy55q]

Case of the week 29/2016
CytoSorb in acute purulent abscess inflammation of the epididymis

Dr. Harald Penz, Department for Anaesthesiology and Intensive Care Medicine, Landesklinikum Gmünd-Waidhofen/Thaya-Zwettl, Location Waidhofen/Thaya, Austria
Summary:

This case study reports on a 69-year-old male patient who fell on his right leg and hip, lying on the lower leg for about 4 hours with his entire weight, who was then salvaged by helpers and brought to the orthopedic department for further examination.
Case presentation

Previously existing inflammatory problem of the epididymis for several days which was treated on an ambulatory basis
X-ray examination showed no deterioration of any bone structures
However, at this time the patient already exhibited elevated levels of creatinine (2.7 mg/dl), CRP (27 mg/dl) and leukocytes (32,000 /µl) as well as highly elevated liver function parameters
The next day there was a further increase of CRP to 40 mg/dl, PCT to 17.3 ng/ml and CK to 24,000 U/l (CK-MB was only minimally increased)
Primary suspicion for urosepsis followed by an immediate transfer to the urology department and subsequent operation with orchiectomy (septic testicles)
Postoperative transfer to ICU and further increase of creatinine (to 8.2 mg/dl within 3 days), urea of 106 mg/dl, glomerular filtration rate of 7 ml/min, despite massive hydration
Initiation of antibiotic therapy with ceftriaxone
Immediately after admission to ICU and due to acute renal failure, a strong increase in plasma levels of inflammatory mediators and increasing needs for catecholamines, CytoSorb therapy was started
Treatment

Six consecutive CytoSorb sessions for a total treatment time of 122 hours, the first two treatments were run for 12 hours, the additional 4 treatments for 24 hours each
CytoSorb was used in conjunction with citrate dialysis (Prismaflex; Gambro) performed in CVVHD mode
Blood flow rate initially 100 ml/min, then increase to 130 ml/min
Anticoagulation: citrate
CytoSorb adsorber position: post-hemofilter
Measurements

Demand for catecholamines
Inflammatory parameters (CRP, PCT)
Renal function (creatinine, glomerular filtration rate)
Creatine kinase (CK) and myoglobin
Results

Within the following 4 days of CytoSorb treatment hemodynamics could be stabilized within just a few hours and catecholamines (norepinephrine) could be tapered out from an initial dose between 0.023-0.035 µg/kg/min in the following days
In these 4 days CRP decreased from initially 40 mg/dl to 6.7 mg/dl, PCT could be reduced from 17.3 ng/dl to 0.64 ng/dl, leucocyte count decreased from 40,000/µl to 11,600/µl
Myoglobin levels were reduced from 311 ng/ml to 104 ng/ml in the same time frame
Likewise, CK- values were lowered from initially 24,000 U/l to 853 U/l and in the further course to 389 U/l
Patient Follow-Up

Eventual diagnosis of the pathologist: Acute purulent abscess inflammation of the epididymis spreading out to the testicles and the tissue of the spermatic cord
13 days after the last CytoSorb treatment the patient was transferred to the normal ward for further therapy in good general condition with further declining CRP (4.6 mg/dl), leukocytes and thrombocytes in the normal range, however still with increased renal retention parameters (creatinine 3.3 mg/dl)
The clinical course of the beginning compartment syndrome of his right leg was also positive
The right calf appeared much softer, no more pressure sensitivity, mobility intact
Gross neurology was recurring and appropriately at the time of documentation, sensitivity present
Conclusions

Significant stabilization and consolidation of hemodynamic and inflammatory parameters during and after CytoSorb therapy
The application of CytoSorb therapy was easy and safe, with no application-specific complications emerging

http://cytosorb-therapy.com/the-therapy/case-of-the-week/