Compassionate use of the Seraph® 100 affinity blood filter in pediatric refractory streptococcal septic shock: a case report

Background: infection can lead to streptococcal toxic shock syndrome, characterized by severe inflammatory dysregulation and rapid clinical deterioration. Extracorporeal blood purification therapies, such as pathogen-binding hemoperfusion, have emerged as potential adjunctive treatments. Case Presentation: . Despite early initiation of broad-spectrum antibiotics, immunoglobulins, vasopressors, mechanical ventilation, and continuous renal replacement therapy, the patient developed severe multiorgan dysfunction and persistent hemodynamic instability. Hemoperfusion was initiated 42 h after pediatric intensive care unit admission. Due to circuit instability, treatment was performed as a stand-alone 4-h session. Following hemoperfusion, a progressive reduction in vasoactive support and improvement in metabolic parameters, including lactate clearance, were observed within 24-48 h. The patient stabilized without requiring veno-arterial extracorporeal membrane oxygenation. However, early severe peripheral ischemia led to bilateral lower-limb amputations. The patient survived and was discharged after prolonged hospitalization. Conclusion: In this case, pathogen-binding hemoperfusion with the Seraph® 100 filter was technically feasible and temporally associated with hemodynamic and metabolic improvement in refractory pediatric septic shock. Although causality cannot be established, these findings suggest a potential role for hemoperfusion as an adjunctive rescue therapy in selected cases. Further prospective studies are needed to determine its safety, optimal timing, and clinical efficacy in pediatric populations.