Hemoadsorption with CytoSorb in Pediatric Patient of Dengue Shock Syndrome: A Case Report
Mohammad Jhahidul Alam *
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Showkat Azad
Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Md Zaved Mehedi Hossain
Department of Internal Medicine, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Faisal Ahmed
Department of Paediatrics and Paediatric Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Sarwar Kashem Russel
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Salman Rahman
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
MD Shahidul Islam
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Asif Saihum
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Masum Billah
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Shantanu Barua
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Muhammad Imran Hossen
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Showrov Sen Emu
Department of Accident & Emergency, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Raju Das
Department of Accident & Emergency, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Mohammed Imran Shukkur
Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Anisa Anan
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Mohammad Saheduzzaman Bhuiyan
Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Diponkar Dutta
Department of Cardiology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Hussein Mohammed Nizamuddin
Department of Critical Care, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Muhammad Mustafizur Rahman
Department of Internal Medicine, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Tausiful Haque, Nargis
Department of Neurology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Nargis Islam Noor
Department of General Surgery, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Avijith Kumar Nath
Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
Tasnia Zafar
Department of Nephrology, Apollo Imperial Hospitals, Chittagong, Bangladesh.
*Author to whom correspondence should be addressed.
Abstract
Dengue Shock Syndrome (DSS), a severe manifestation of dengue virus infection, poses significant challenges in pediatric populations due to its rapid progression to systemic inflammation and multi-organ dysfunction syndrome (MODS). Conventional management often proved inadequate in fulminant cases. CytoSorb hemoadsorption, an extracorporeal cytokine removal therapy, has shown promise in controlling cytokine storms associated with critical illness but remains underexplored in dengue. We reported the case of a 13-year-old male presenting with DSS complicated by respiratory failure, coagulopathy, renal impairment, and persistent shock unresponsive to standard treatment. Despite intensive supportive care, including mechanical ventilation, vasopressors, and blood products, the patient's condition continued to deteriorate. CytoSorb therapy was initiated as a rescue intervention. Two sessions led to rapid clinical and laboratory improvements, including resolution of shock, normalization of inflammatory markers (IL-6, CRP, lactate), improved oxygenation, and recovery of organ function. The patient was extubated within 48 hours of the second session and was shifted to ward in stable condition by ICU day 7.
This case highlighted the potential utility of CytoSorb hemoadsorption as an effective adjunctive therapy in severe DSS with MODS, particularly where traditional approaches are insufficient. Further studies are warranted to validate its efficacy in pediatric dengue care.
Keywords: CytoSorb, dengue, shock syndrome, case report