Effective management of pediatric septic shock: a case study utilizing continuous renal replacement therapy with cytosorb and citrate in a leukemic patient with hyper-interleukin (IL)-6-naemia and severe thrombocytopenia.

Abstract

Background: Sepsis is a critical condition characterized by a dysregulated immune response to infection, often resulting in organ dysfunction. Interleukin-6 (IL-6) is a key proinflammatory cytokine associated with sepsis and its complications. This case study explored the use of Continuous Renal Replacement Therapy (CRRT) combined with Cytosorb in managing pediatric patients with leukemia, severe thrombocytopenia, and elevated IL-6 levels.

Case presentation: A 10-year-old boy with Fanconi anemia presented with pancytopenia, fever, and necrotic lesions, indicative of mucormycosis. Following the diagnosis of acute myeloid leukemia (AML), the patient experienced severe complications, including septic shock. Despite appropriate treatment, inflammatory markers, such as C-reactive protein (CRP), procalcitonin (PCT), and IL-6, were significantly elevated. CRRT with Cytosorb was initiated to manage hypercytokinemia and improve the patient's clinical status.

Intervention: The CRRT procedure utilizes citrate as an anticoagulant because of severe thrombocytopenia. The treatment lasted for 20 h, during which the inflammatory biomarkers were monitored. The post-treatment results indicated a significant reduction in IL-6 levels within 24 h and a decrease in PCT levels at 8 h. CRP levels gradually declined over 40 h.

Outcome: The patient exhibited marked clinical improvement, with significant healing of cutaneous lesions and stabilization of inflammatory markers, allowing transfer to the ward for continued chemotherapy.

Conclusion: This case suggests that CRRT combined with cytosorb may be a valuable adjunctive therapy for managing complex cases of septic shock. The observed reduction in inflammatory markers, particularly IL-6, warrants further investigation. Concurrent antimicrobial, antifungal, and dexamethasone treatments for IRIS may have influenced the observed outcomes in this single case. Controlled studies are needed to evaluate the specific contribution of Cytosorb-CRRT and assess its long-term efficacy and safety in similar patient populations, particularly in resource-limited settings.

Clinical trial number: Not applicable.