Hyperinflammatory septic shock during immune reconstitution: Temporal association with HA-330 hemoadsorption: A case report
Hyperinflammatory shock and HA-330 hemoadsorption
DOI:
https://doi.org/10.54205/ccc.v34.280152Keywords:
Septic shock, Hemoperfusion, HA-330Abstract
Introduction: Immune-recovery phases after intensive chemotherapy can abruptly trigger hyperinflammatory responses that amplify vasoplegia in septic shock. Recognizing this phenotype is crucial, particularly when the inflammatory burden is disproportionate to the source of infection.
Case presentation: A 56-year-old woman with acute B-cell lymphoblastic leukemia developed sudden vasoplegic shock during profound neutropenia with Granulocyte colony-stimulating factor (G-CSF) support following administration of hyperfractionated cyclophosphamide, vincristine, adriamycin (doxorubicin), and dexamethasone ( Hyper-CVAD). She presented with severe hyperlactatemia (11 mmol/L), C-reactive protein (CRP) 232 mg/L, procalcitonin >100 ng/mL, and extreme elevation of interleukin-6 (IL-6) (371,464 pg/mL). Despite timely broad-spectrum antibiotics, hydrocortisone, aggressive fluid resuscitation, and high-dose dual vasopressors, profound vasoplegia persisted. Urine output remained partially preserved (0.33–0.93 mL/kg/h) in the setting of predominantly vasodilatory circulatory failure.
Intervention and outcome: Three sessions of HA-330 hemoadsorption (Jafron Biomedical, Zhuhai, China) over 72 hours were initiated after failure of conventional therapy. IL-6 declined from 371,464 to 23,629 pg/mL after the first session and to 517 pg/mL after the third session. This was temporally associated with progressive reduction in vasopressor requirements and lactate normalization. Hemodynamic stability was achieved with improved organ perfusion.
Conclusions: This case highlights a cytokine-dominant vasoplegic septic shock phenotype during immune recovery, marked by extraordinary IL-6 elevation despite partially preserved renal perfusion. The temporal alignment between hemoadsorption, cytokine reduction, and hemodynamic improvement is hypothesis-generating and underscores the potential role of inflammatory burden in certain hyperinflammatory shock states.
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References
Mokart D, Kipnis E, Guerre-Berthelot P, Vey N, Capo C, Sannini A, et al. Monocyte deactivation in neutropenic acute respiratory distress syndrome patients treated with granulocyte colony-stimulating factor. Crit Care. 2008;12:R17. doi: https://doi.org/10.1186/cc6791.
Azoulay E, Darmon M. Acute respiratory distress syndrome during neutropenia recovery. Crit Care. 2010;14:114. doi: https://doi.org/10.1186/cc8198.
Chousterman BG, Arnaud M. Is there a role for hematopoietic growth factors during sepsis? Front Immunol. 2018;9:1015. doi: https://doi.org/10.3389/fimmu.2018.01015.
Moore AR, Zheng H, Ganesan A, Hasin-Brumshtein Y, Maddali MV, Levitt JE, et al. A consensus immune dysregulation framework for sepsis and critical illnesses. Nat Med. 2025;31:4084–4096. doi: https://doi.org/10.1038/s41591-025-03956-5.
Antcliffe DB, Burnham KL, Al-Beidh F, Santhakumaran S, Brett SJ, Hinds CJ, et al. Transcriptomic signatures in sepsis and a differential response to steroids. From the VANISH randomized trial. Am J Respir Crit Care Med. 2019;199:980–986. doi: https://doi.org/10.1164/rccm.201807-1419OC.
Waalders NJB, Kox M, Pickkers P. Haemoadsorption to remove inflammatory mediators in sepsis: past, present, and future. Intensive Care Med Exp. 2025;13:38. doi: https://doi.org/10.1186/s40635-025-00740-0.
Sazonov V, Abylkassov R, Tobylbayeva Z, Saparov A, Mironova O, Poddighe D. Hemoadsorption with HA-330 adsorber in septic pediatric patients with cancer. Front Pediatr. 2021;9:672260. doi: https://doi.org/10.3389/fped.2021.672260.
Ruiz-Rodríguez JC, Chiscano-Camón L, Ruiz-Sanmartin A, Costa-Allué N, Bajaña I, Nicolas-Morales P, et al. Critical hypercytokinemia in sepsis and septic shock: identifying interleukin-6 thresholds beyond which mortality risk exceeded survival probability. J Clin Med. 2026;15(3):1057. doi: https://doi.org/10.3390/jcm15031057.
Xu X, Jia C, Luo S, Li Y, Xiao F, Dai H, et al. Effect of HA330 resin-directed hemoadsorption on a porcine ARDS model. Ann Intensive Care. 2017;7:84. doi: https://doi.org/10.1186/s13613-017-0287-0.
Ronco C, Bonello M, Bordoni V, Ricci Z, D'Intini V, Bellomo R, et al. Extracorporeal therapies in non-renal disease: treatment of sepsis and the peak concentration hypothesis. Blood Purif. 2004;22(1):164–174. doi: https://doi.org/10.1159/000074937.
Sánchez-Morán F, Mateu-Campos ML, Bernal-Julián F, Gil-Santana A, Sánchez-Herrero Á, Martínez-Gaspar T. Haemoadsorption combined with continuous renal replacement therapy in abdominal sepsis: case report series. J Pers Med. 2023;13(7):1113. doi: https://doi.org/10.3390/jpm13071113.
Li Y, Han M, Yang M, Su B. Hemoperfusion with the HA330/HA380 cartridge in intensive care settings. Blood Purif. 2025;54(2):122–137. doi: https://doi.org/10.1159/000542469.
Paul R, Ansari ASA, Ballesteros D, Klaus T, Honoré PM. Current knowledge on the impact of extracorporeal blood purification devices on drug clearance: systematic search and narrative review. Blood Purif. 2025;54(12):733–744. doi: https://doi.org/10.1159/000547477.
Wang C, Li C, Yang P, Liu K, Xiong X, Liu Y, et al. High adsorption capacity of hemoperfusion on imipenem in critically ill patients with septic shock: a case report. BMC Infect Dis. 2024;24:894. doi: https://doi.org/10.1186/s12879-024-09774-3.
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