Single use of cytokine-adsorption-membrane Oxiris® in the treatment of severe malaria with acute kidney injury: a case-report

Background: Malaria´s treatment improved throughout the last decades mainly focused on eradicating the plasmodium. Nevertheless, its severe form is still a threat to over half the world’s population leaving opportunities to evaluate new approaches in managing the cytokine storm often associated with these cases. Case Presentation A previously healthy 60 years-old male was hospitalized due to a prolonged high fever after a recent visit to the Equatorial Guinea. The Plasmodium Falciparum Malaria diagnosis was made and soon after hospital admission his clinical condition rapidly deteriorated with hemodynamic instability, need of mechanical ventilation and acute kidney injury. Continuous renal replacement therapy (CRRT) was initiated using the Oxiris ® filter, an endotoxin and cytokines adsorption membrane currently used in our center in septic shock especially when due to gran negative bacteria. In the present case, the rational for its prescription was based on the similarity of sepsis and malaria cytokine storm in severe cases. A remarkable clinical improvement started within 24 hours after CRRT, followed by a clear decreasing in blood inflammatory mediators after 72 hours of its initiation (lactate: from 71 to 20 mg/dL; procalcitonin: from 73.9 to 33ng/L, interleukin-6: from 590 to 106 pg/mL). Seven days after admission, the patient acquired a ventilator-ssociated pneumonia, and targeted antimicrobial treatment was started. Because of multiple complications related to long in-hospital stay, patient remained hospitalized for five months before being discharged. He recovered renal function and no longer needed renal replacement therapy after discharge. Conclusions There are no previous or ongoing trials regarding the use of endotoxins and cytokines adsorbing membranes in the setting of severe malaria. The prompt clinical and laboratory improvement after the initiation of blood purification suggests cytokine adsorptive filters may have a beneficial impact in those cases.