CASE REPORT article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicExtracorporeal Organ Support: Innovations and Challenges in Critical CareView all 14 articles
A role for Hemoadsorption in Hemophagocytic Lymphohistiocytosis
Provisionally accepted
- 1Hospital de Sousa Martins, Guarda, Portugal
- 2Unidade Local de Saude da Guarda EPE, Guarda, Portugal
- 3Hospital Curry Cabral, Lisbon, Portugal
- 4Unidade Local de Saude Sao Jose, Lisbon, Portugal
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Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening hyperinflammatory syndrome. HLH can occur as a primary (familial) or secondary (acquired) disorder. Secondary HLH (sHLH) manifests in response to infection, malignancy, autoimmune disorders or drugs. Presentation is usually non-specific, with fever, cytopenias, elevated inflammatory markers and hepatosplenomegaly. A high level of suspicion coupled with the use of diagnostic scores (HScore and HLH-2004) is required for timely diagnosis. Specific studies such as bone marrow biopsy or soluble interleukin-2 (IL-2) receptor (CD25) levels are necessary for distinguishing HLH from other conditions, but should not delay treatment. Corticosteroids, in addition to other immunossupressants, should be initiated promptly in order to reduce morbidity and mortality. In secondary cases, treatment of underlying causes is necessary for complete remission. Long-term immunossupression may be required beyond resolution of the HLH trigger to avoid relapses. We report a case of severe acute HLH in a patient with distributive and cardiogenic shock and multiorgan dysfunction. The patient was successfully treated with CytoSorb® hemoadsorption therapy. This case highlights diagnostic challenges, therapeutic interventions, and the potential role of hemoadsorption therapy as a complementary treatment option for HLH.
Keywords: Hemophagocytic lymphohistiocytosis (HLH), Secondary HLH, Cytokine storm, Hemoadsorption, CytoSorb ®, Extracorporeal blood purification, Continuous renal replacement therapy (CRRT), Critical Care
Received: 20 Oct 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Pereira, Vieira, Duarte and Germano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Miguel Gonçalves Pereira
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