ADJUNCTIVE HEMOPERFUSION (HA 330) IN THE MANAGEMENT OF HIGH-RISK PNEUMONIA AND ACUTE KIDNEY INJURY IN SYSTEMIC LUPUS ERYTHEMATOSUS WITH UPPER GASTROINTESTINAL BLEEDING

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by complement and innate immune dysfunction leading to increased susceptibility to infection and higher infection-related mortality. While hemoperfusion has been explored in inflammatory and immunocompromised states, reports of its use with broad-spectrum adsorbent cartridges such as HA 330 in SLE remain scarce.

A 54-year-old female newly diagnosed case of SLE who underwent methylprednisolone pulse therapy in March 2025 and subsequently maintained on daily Prednisone 25 mg, Hydroxychloroquine 200 mg, and  Mycophenolate mofetil 500 mg was admitted for evaluation of melena. 

The patient came in hemodynamically stable with her physical examination showing generalized pallor consistent with laboratory findings of severe anemia (Hgb 26 g/L). Additional bloodwork showed leukopenia (3.87 ×10⁹/L) and marked lymphopenia (0.23%), along with hypoalbuminemia (20.1 g/L) and an elevated serum creatinine (1.44 mg/dL). Urinalysis revealed trace albuminuria, hematuria (3 RBCs/hpf), and pyuria (49 WBCs/hpf). Both direct and indirect Coombs tests were negative. Lungs were clear on auscultation, and heart sounds were normal with no murmurs. The abdomen was soft, non-tender, and non-distended but there was note of grade I bipedal edema. Baseline chest X-ray was unremarkable. 

Following correction of anemia (Hgb 103g/L), the patient underwent esophagogastroduodenoscopy (EGD) which revealed Forrest III duodenal ulcer, erosive gastroduodenitis, and Helicobacter pylori infection.  During hospitalization, the patient developed hypotension (blood pressure 80/60 mmHg), productive cough, chills, desaturation (90–92%) and bilateral coarse crackles. Vasopressor support was initiated and empiric antibiotic therapy with Piperacillin-Tazobactam was given for consideration of hospital acquired pneumonia. Inflammatory markers were markedly elevated: procalcitonin >100 ng/mL, C-reactive protein 49.6 mg/L accompanied by leukocytosis (14.5 × 10⁹/L) and rising serum creatinine (1.93 mg/dL). Sputum culture subsequently showed heavy growth of Acinetobacter baumannii supporting the diagnosis of hospital acquired pneumonia while blood cultures yielded Staphylococcus aureus and Staphylococcus epidermidis that were considered contaminants.

Intermittent hemodialysis in combination with Jafron HA330 hemoperfusion was administered daily for three consecutive days to manage septic shock from pneumonia and acute kidney injury. Following the initial hemoperfusion session, the patient’s blood pressure stabilized at 130/90 mmHg without the need for further vasopressor support. After completion of three hemodialysis with hemoperfusion sessions, the patient demonstrated notable clinical improvement, accompanied by a marked decline in inflammatory markers: procalcitonin (1.29 ng/mL),  C-reactive protein (4.5 mg/L), reduction in serum creatinine (1.4 mg/dL) and resolution of leukocytosis (5 × 10⁹/L) as summarized in Table 1. A follow-up chest radiograph also showed significant improvement in pulmonary infiltrates and congestion (Figure 1).

Emerging evidence supports the use of hemoperfusion as an adjunctive therapy in managing severe infections owing to its ability to adsorb pro‑inflammatory cytokines and protein-bound toxins. In the case reported, the use of HA330 in hemoperfusion significantly reduced inflammatory markers in the setting of an underlying autoimmune condition (SLE) suggesting immunomodulatory benefits beyond toxin removal. 

This novel application of hemoperfusion highlights the potential of hemoperfusion with HA330 as a valuable adjunctive therapy in critically ill autoimmune patients with severe infections and multi-organ dysfunction. The clinical improvement observed in this case supports the need for further investigation into the broader role of hemoperfusion in similar high-risk populations.