ADJUNCTIVE HEMOADSORPTION WITH DNA 230 IN SEVERE SYSTEMIC LUPUS ERYTHEMATOSUS WITH MULTIORGAN INVOLVEMENT: A CASE REPORT

Systemic lupus erythematosus (SLE) is an autoimmune disease marked by immune-complex deposition and multiorgan involvement. Lupus nephritis (LN) is a major cause of morbidity in young women and may present as acute kidney injury (AKI) requiring renal replacement therapy. Although corticosteroids and immunosuppressants remain standard therapy, adjunctive extracorporeal modalities such as hemoadsorption have emerged to attenuate hyperinflammation by removing circulating cytokines and immune mediators. We report a case of severe SLE with multiorgan activity successfully managed with hemoadsorption using DNA 230 cartridges in addition to conventional therapy.

This descriptive case report reviews the course of a 25-year-old woman admitted at East Avenue Medical Center for fever and dyspnea during an SLE flare. Clinical presentation, laboratory data, imaging findings, and treatment response were documented from admission to discharge. Key interventions included corticosteroid pulse therapy, hemodialysis, and adjunctive hemoadsorption with DNA 230. Trends in renal function, inflammatory markers, and organ involvement were analyzed descriptively to assess temporal response.

The patient presented with three weeks of progressive edema, fever, malar rash, and dyspnea. On admission, she was alert, BP 140/90 mm Hg, HR 120 bpm, T 36.5 °C, RR 21/min, SpO₂ 98%, with bibasal crackles and bipedal edema.
Initial laboratory results showed anemia (Hb 113 g/L), creatinine 603 µmol/L, BUN 22.9 mmol/L, hyponatremia 133 mmol/L, hyperkalemia 6.5 mmol/L, and hyperphosphatemia 2.8 mmol/L. Inflammatory markers Procalcitonin 3.8 ng/mL and CRP 2.1 mg/L were elevated. ABG revealed HAGMA + NAGMA with adequate oxygenation. Urinalysis showed proteinuria, hematuria, and leukocytosis. Imaging revealed bilateral pleural effusion and renal parenchymal disease with minimal ascites. She exhibited SLE activity in renal, mucocutaneous, serosal, hematologic, and immunologic domains.
She was started on ceftriaxone, paracetamol, N-acetylcysteine, hydrocortisone, calcium + vitamin D, losartan, and atorvastatin. Hemodialysis was initiated on day 3 for worsening azotemia and oliguria. On day 11, she developed seizures and decreased sensorium. CXR showed progression of pleural effusion; Cranial CT showed acute cerebellar infarcts; 2D echo revealed LV hypertrophy with global hypokinesia and EF 32%, consistent with systemic inflammation. To modulate hypercytokinemia, two sessions of hemoadsorption with DNA 230 were performed with dialysis. After the second session, marked improvement was observed—defervescence, relief of dyspnea, reduction of effusions, normalization of inflammatory markers, and decline in serum creatinine. She was discharged stable on day 25 on tapering corticosteroids with a scheduled renal biopsy.

Renal, liver and inflammatory markers

This case highlights the potential role of DNA 230 hemoadsorption as an adjunct to standard immunosuppression and dialysis in severe lupus with multiorgan involvement. By facilitating removal of cytokines and inflammatory mediators, hemoadsorption may accelerate recovery and improve organ function during lupus flares.