A case report to highlight the impact of extracorporeal cytokine elimination therapy in viper snakebite induced septic shock with acute kidney injury

Abstract

Introduction: Snakebite envenomation can lead to prolonged disruption of hemostasis, neuromuscular paralysis, myolysis (muscle degeneration) followed by release of damage associated molecular patterns, acute kidney injury and hypovolaemic shock due to underlying cytokine storm. Extracorporeal cytokine adsorption device can be used to address the cytokine storm. Patients and Methods: A 40-year-old male patient underwent hypotensive and circulatory shock post viper snakebite making it difficult to maintain mean arterial pressure (MAP) >65 mmHg. Standard of care was ensured. Further, the patient progressed towards septic shock and multi organ failure, starting with acute respiratory distress syndrome followed by acute kidney injury. Inflammatory markers were indicative of cytokine storm. Considering the severity, extracorporeal cytokine adsorption device (CytoSorb) was initiated along with hemodialysis for 8 hours. Results: Post CytoSorb, noradrenaline dose was reduced and eventually terminated. The ventilation support was weaned. Circulatory shock was restored which was evident by the normalization of hemoglobin, platelet counts and leukocyte counts. Procalcitonin dropped considerably from the baseline. Eventually Sequential Organ Failure Assessment (SOFA) score reduced significantly to 1, which, at the time of admission, was 14. Conclusions: Extracorporeal cytokine adsorption device along with standard of care appears a promising approach towards better outcome post snakebite induced multi organ failure.

Keywords

• viper envenomation
• septic shock
• coagulopathy
• acute kidney injury
• cytosorb