MP851PEDIATRIC PATIENT WITH DENGUE FEVER AND ASSOCIATED MULTIORGAN DYSFUNCTION SYNDROME (MODS) RECEIVING HAEMOADSORPTION USING CYTOSORB - A CASE REPORT ON CLINICAL EXPERIENCE

Abstract

INTRODUCTION AND AIMS: Cytokine adsorber (Cytosorb) is considered to be a successful adjunctive therapy for adult patients with elevated cytokine levels in severe sepsis, septic shock with multi organ dysfunction and to reduce bilirubin along with various toxic metabolites. METHODS: We present the case of a 10- year old boy who was admitted to our hospital due to dengue hemorrhagic fever with thrombocytopenia, coagulopathy, SIRS, acute fulminant hepatic failure with encephalopathy and oliguria. This patient was successfully treated by a combination of standard care and hemoadsorption with Cytosorb . RESULTS: On admission, his liver function parameters and other blood parameters were closely monitored. In spite of hepaticprotective strategies, over a 36 hour period a drastic increase was observed in transaminases and bilirubin with maximum values of SGOT-11,391(IU/L), SGPT- 4,572 (IU/L), total bilirubin 7.2mg/dl; direct 5.1 and indirect 2.1 respectively., He also had Coagulopathy with aPTT-56.3 and INR 2.1;persistent thrombocytopenia(18000/cumm) with oliguria, anasarca , altered sensorium requiring mechanical ventilation and ionotrope support. Due to the condition of the child, in view of the Multi Organ Dysfunction Syndrome (MODS) an adjunctive therapy with Cytosorb was initiated. After an 18 hour procedure, his liver function tests (LFTs) improved with values of SGOT- 8,003(IU/L), SGPT-3,573(IU/L); total bilirubin-4.8mg/ dl and platelet count remarkably increased to 108000 (per mcL). LFTs further decreased and normalized values were attained over 5 days. The patient was extubated on day 9 of admission. Subsequently, the patient was discharged in an active, afebrile and hemodynamically stable condition. CONCLUSIONS: This case is the first report on the application of Cytosorb hemoadsorption in a pediatric patient with dengue fever and MODS treated successfully with standard of care along with Cytosorb . It can be a safe and advantageous extra corporeal therapy option to treat pediatric dengue patients with MODS to help them recover.