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It emphasizes non-specific presentation, the need for high diagnostic suspicion with tools such as HScore and HLH-2004, and timely initiation of corticosteroids. A severe acute HLH case with distributive and cardiogenic shock and multiorgan dysfunction was treated successfully using CytoSorb® hemoadsorption as a complementary option.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/case-report-a-role-for-hemoadsorption-in-hemophagocytic-lymphohistiocytosis/411128/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/case-report-a-role-for-hemoadsorption-in-hemophagocytic-lymphohistiocytosis/411128.png","ImageObject",300,407,{"name":92,"@type":93},"Rizky","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is hemophagocytic lymphohistiocytosis (HLH) in this case report?","Question",{"text":112,"@type":113},"HLH is presented as a rare but life-threatening hyperinflammatory syndrome that can be primary (familial) or secondary (acquired). 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T. Nguyen,  \nUniversity of North Carolina at Chapel Hill, United States  \n*CORRESPONDENCE  \nMiguel Gonçalves Pereira  \n [miguel14.pereira@gmail.com](miguel14.pereira@gmail.com)  \nRECEIVED 20 October 2025  \nREVISED 23 November 2025  \nACCEPTED 27 November 2025  \nPUBLISHED 18 December 2025  \nCITATION  \nPereira MG, Vieira CB, Duarte TI and Germano N (2025) Case Report: A role for hemoadsorption in hemophagocytic lymphohistiocytosis.  \nFront. Med. 12:1729061 .  \ndoi: 10.3389/fmed.2025.1729061  \nCOPYRIGHT  \n© 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) and the copyright owner(s) 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.  \nTYPE Case Report  \nPUBLISHED 18 December 2025 DOI 10.3389/fmed.2025.1729061  \nCase Report: A role for hemoadsorption inhemophagocytic lymphohistiocytosis  \nMiguel Gonçalves Pereira 1*, César Burgi Vieira 2, Tiago Isidoro Duarte 2 and Nuno Germano 2  \n1Department of Intensive Care Medicine, Unidade Local de Saúde da Guarda, Hospital Sousa Martins, Guarda, Portugal, 2Department of Intensive Care Medicine, Unidade Local de Saúde de São José, Hospital Curry Cabral, Lisbon, Portugal  \nHemophagocytic 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 maybe 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.  \nKEYWORDS  \nhemophagocytic lymphohistiocytosis, secondary HLH, cytokine storm, hemoadsorption, CytoSorb®, extracorporeal blood purification, continuous renal replacement therapy, critical care  \n1 Introduction  \nHemoadsorption is an extracorporeal technique that attempts to reduce hyperinflammatory states by removing circulating cytokines and other hydrophobic molecules. The CytoSorb® device uses biocompatible porous polymer beads that adsorb molecules between 5 and 60 kDa, which includes key mediators in HLH. By lowering the circulating cytokine burden, without adding pharmacological immunosuppression, hemoadsorption might work as a useful adjunct in infection-triggered HLH-a context where conventional immunosuppression can make the underlying infection worse. Its use in HLH is still quite new. Evidence comes mostly from case reports, but ther","cbCaibUd0r04uRhP","https://ap.wps.com/l/cbCaibUd0r04uRhP","pdf",224381,"English","# Introduction\n## Hemoadsorption and rationale in HLH\n# Background on HLH and diagnostic scoring","[{\"question\":\"What is hemophagocytic lymphohistiocytosis (HLH) in this case report?\",\"answer\":\"HLH is presented as a rare but life-threatening hyperinflammatory syndrome that can be primary (familial) or secondary (acquired). Secondary HLH is described as arising in response to infection, malignancy, autoimmune disorders, or drugs.\"},{\"question\":\"Why are diagnostic scores like HScore and HLH-2004 emphasized?\",\"answer\":\"The report explains that HLH often has non-specific symptoms, and timely diagnosis requires high clinical suspicion supported by diagnostic scores. Specific studies and criteria are needed to distinguish HLH from other conditions, without delaying treatment.\"},{\"question\":\"How was CytoSorb® hemoadsorption used, and what is its proposed role?\",\"answer\":\"The patient in the report was treated successfully with CytoSorb® hemoadsorption therapy. The mechanism described is extracorporeal removal of cytokines and other molecules to reduce hyperinflammatory burden, potentially serving as a complementary treatment option as evidence is still emerging.\"}]","Case Report: A role for hemoadsorption in hemophagocytic lymphohistiocytosis | PDF",1790587531,13]