Hemoadsorption with CytoSorb in Pediatric Patient of Dengue Shock Syndrome: A Case Report

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.