Multistep extracorporeal support strategy for community-acquired pneumonia complicated by sepsis and multiple organ failure (A clinical case)

This article presents a clinical case report of a 49-year-old male patient with severe community-acquired bilateral polysegmental pneumonia, complicated by sepsis and multiple organ failure including acute kidney injury (AKI) with oliguria, severe hyperbilirubinemia, and thrombocytopenia with suspected thrombotic microangiopathy (TMA). Objective: To demonstrate strategies for the differential diagnosis of TMA in severe pneumonia and the sequential use of extracorporeal therapies (ECT). Severity was assessed using the SOFA score. Renal replacement therapy (RRT) was performed as continuous veno-venous hemofiltration (CVVH) in three intervals. Therapeutic plasma exchange (TPE) consisted of two sessions, each involving two volumes of circulating plasma. Prior to ECT, a blood sample was collected to measure ADAMTS13 activity. In the context of complex therapy involving CVVH and TPE, the SOFA score decreased from 12 to 7 points. Additionally, the platelet count increased from 30 × 10⁹/L to 187 × 10⁹/L, bilirubin levels decreased from 559.6 to 16.6 μmol/L, and diuresis was restored. However, ADAMTS13 activity was only 19%, which requires further interpretation considering the presence of sepsis. This case highlights the importance of early TMA diagnosis, ADAMTS13 blood testing before ECT, and the effectiveness of early plasmapherapy.

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