THERAPEUTIC PLASMA EXCHANGE IN SEPTIC SHOCK

Abstract

Introduction: Therapeutic plasma exchange (TPE) is an emerging adjunctive therapy in septic shock, a condition marked by dysregulated immune response and high mortality. By removing circulating inflammatory mediators, endotoxins, and other pathogenic substances, TPE aims to restore immune balance and improve hemodynamic stability  
 
Case: A 52-year-old female patient presenting with shock sepsis secondary to pneumonia, She was admitted in a critical condition, already intubated and receiving IV fluids, and subsequently underwent three cycles of TPE each with a total replacement volume of 2700 cc consisting of diluted albumin 25%, Gelafusal, and normal saline. She developed left pleural effusion, hypoalbuminemia, and anemia, and was supported with comprehensive antimicrobial therapy including cefepime, amikacin, and antifungal micafungin, as well as corticosteroids and pyridostigmine via NGT. Invasive lines including a CVC, femoral DLC, and radial arterial line were placed. Her condition gradually improved with passive mobilization, nutritional optimization, regular suctioning, and eye care. After 18 days of ICU treatment, she was transferred to a lower-dependency unit with stable hemodynamics, improving lab parameters, and internal medicine follow-up.
 
Discussion: The presented case underscores the promising role of TPE an adjunctive treatment in septic shock, by demonstrating clinical improvement following targeted immunomodulation and removal of inflammatory mediators. In this 52-year-old female patient, TPE contributed to hemodynamic stabilization and reduction of systemic inflammation over three treatment cycles, amidst a complex ICU course involving pneumonia, pleural effusion, and multiple invasive interventions.
 
Conclusion: This case highlights the critical role of TPE in managing septic shock secondary to pneumonia and cytokine storm in a 52-year-old female patient.