Blood purification for treatment of non-liquefied multiple liver abscesses and improvement of T-cell function: A case report

Abstract

BACKGROUND

Non-liquefied multiple liver abscesses (NMLA) can induce sepsis, septic shock, sepsis-associated kidney injury (SA-AKI), and multiple organ failure. The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines, exacerbating organ damage, and potentially causing immunosuppression and T-cell exhaustion. Therefore, the search for additional effective treatments that complement antibiotic therapy is of great importance.

CASE SUMMARY

A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting, diarrhea, and decreased urine output. The patient exhibited a temperature of 37.8 °C. Based on the results of liver ultrasonography, laboratory tests, fever, and oliguria, the patient was diagnosed with NMLA, sepsis, SA-AKI, and immunosuppression. We administered antibiotic therapy, entire care, continuous renal replacement therapy (CRRT) with an M100 hemofilter, and hemoperfusion (HP) with an HA380 hemofilter. The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors. In addition, the treatment stimulated the expansion of the cluster of differentiation 8⁺ (CD8⁺) T-cells and led to the complete recovery of renal function. The patient was discharged from the hospital. During the follow-up period of 28 d, she recovered successfully.

CONCLUSION

Based on the entire therapeutic regimen, the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections, reduce inflammatory responses, and improve CD8⁺ T-cell immune function.

Keywords: Non-liquefied multiple liver abscesses; Sepsis; Acute kidney injury; Continuous renal replacement therapy; Hemoperfusion; Case report

Core Tip: Non-liquefied multiple liver abscesses (NMLA) can lead to sepsis, septic shock, and sepsis-associated kidney injury (SA-AKI). Early treatment with continuous renal replacement therapy (CRRT) and hemoperfusion (HP) is particularly important when the patient is not a candidate for ultrasound-guided drainage or surgical intervention. The combination of CRRT and HP is used to control infections, reduce inflammation, and promote T-cell function. This case highlights the importance of holistic treatment in managing septic shock and SA-AKI caused by NMLA and the potential benefits of timely CRRT and HP therapy.