Application of combined hemadsorption with eculizumab as rescue treatment of a pediatric patient with multiple organ failure related to severe hemolytic uremic syndrome

Many different extracorporeal blood purification techniques have been proposed in critically ill adult patients with sepsis and sepsis-like syndromes. In this context, hemoperfusion devices such as CytoSorb have been recently approved for extracorporeal cytokine removal. In the neonatal and pediatric setting however, the application of this method brings with it various challenges including profound technical difficulties with data for its application in critically ill pediatric patients remaining sparse. We present a case of a 2-year-old female patient affected by severe Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome (STECHUS) admitted to our Intensive Care Unit (ICU) with anuria, hemodynamic instability and severe neurological deterioration. By using a combined “rescue” therapy regimen with hemodiafiltration, hemadsorption (CytoSorb), plasmapheresis (PEX) and Eculizumab, the patient could be successfully stabilized, accompanied by a control of the hyperinflammatory response and an improvement in the neurological condition, finally leading to recovery. In pediatric patient extracorporeal blood purification techniques might potentially represent a promising adjuvant therapeutic option for the complications related to hemolytic uremic syndrome and hyperinflammation, but further studies are needed.