Frontiers in Medicine (Aug 2022)

Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma

  • Juan Carlos Ruiz-Rodríguez,
  • Juan Carlos Ruiz-Rodríguez,
  • Juan Carlos Ruiz-Rodríguez,
  • Luis Chiscano-Camón,
  • Luis Chiscano-Camón,
  • Luis Chiscano-Camón,
  • Adolf Ruiz-Sanmartin,
  • Adolf Ruiz-Sanmartin,
  • Adolf Ruiz-Sanmartin,
  • Clara Palmada,
  • Clara Palmada,
  • Ivan Bajaña,
  • Ivan Bajaña,
  • Gloria Iacoboni,
  • Gloria Iacoboni,
  • Camilo Bonilla,
  • Camilo Bonilla,
  • Alejandra García-Roche,
  • Alejandra García-Roche,
  • Erika Paola Plata-Menchaca,
  • Erika Paola Plata-Menchaca,
  • Erika Paola Plata-Menchaca,
  • Carolina Maldonado,
  • Carolina Maldonado,
  • Marcos Pérez-Carrasco,
  • Marcos Pérez-Carrasco,
  • Marcos Pérez-Carrasco,
  • Mónica Martinez-Gallo,
  • Mónica Martinez-Gallo,
  • Mónica Martinez-Gallo,
  • Mónica Martinez-Gallo,
  • Clara Franco-Jarava,
  • Clara Franco-Jarava,
  • Manuel Hernández-González,
  • Manuel Hernández-González,
  • Manuel Hernández-González,
  • Ricard Ferrer,
  • Ricard Ferrer,
  • Ricard Ferrer

DOI
https://doi.org/10.3389/fmed.2022.925751
Journal volume & issue
Vol. 9

Abstract

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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.

Keywords