Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma
Juan Carlos Ruiz-Rodríguez et al. Front Med (Lausanne). 2022.
Hide details
Front Med (Lausanne)
. 2022 Aug 15;9:925751.
doi: 10.3389/fmed.2022.925751. eCollection 2022.
Authors
Juan Carlos Ruiz-Rodríguez 1 2 3 , Luis Chiscano-Camón 1 2 3 , Adolf Ruiz-Sanmartin 1 2 3 , Clara Palmada 1 2 , Ivan Bajaña 1 2 , Gloria Iacoboni 3 4 , Camilo Bonilla 1 2 , Alejandra García-Roche 1 2 , Erika Paola Plata-Menchaca 1 2 3 , Carolina Maldonado 1 2 , Marcos Pérez-Carrasco 1 2 3 , Mónica Martinez-Gallo 3 5 6 7 , Clara Franco-Jarava 5 6 , Manuel Hernández-González 5 6 7 , Ricard Ferrer 1 2 3
Affiliations
1 Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
2 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.
3 Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
4 Hematology Department, Vall d'Hebron Hospital Universitari, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
5 Immunology Division, Vall d'Hebron University Hospital, Barcelona, Spain.
6 Diagnostic Immunology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
7 Department of Cell Biology, Physiology and Immunology, Autonomous University of Barcelona (UAB), Barcelona, Spain.
PMID: 36045925
PMCID: PMC9423101
DOI: 10.3389/fmed.2022.925751
Cite
Abstract
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.
