title: Role of hemodialysis with high cut-off membranes in a patient with a non-recognized leishmaniasis.
abstract: BACKGROUND
  We report here a case of a woman affected by fever, weight loss, splenomegaly, and leucopenia associated with trombocytopenia, transferred to the intensive care unit with acute kidney injury and septic shock.
  
  
  METHODS
  Patient was treated with high cut-off continuous veno-venous hemodialysis (HCO-CVVHD).
  
  
  RESULTS
  During treatment, the patient experienced a stable improvement in the hemodynamic, pulmonary function and tissue perfusion parameters. After 48 h of treatment, significant reductions in SOFA score (from 12, before starting the procedure, to 6) and in serum inflammatory mediators (as IL-6, from 599-568 pg/ml) were observed. Leishmania infection was identified as responsible of the septic condition only 48 h after removing hemodialysis. Antiprotozoal therapy was begun and the patient discharged.
  
  
  CONCLUSIONS
  By supporting the renal function and reducing systemic inflammation, HCO-CVVHD could be a useful bridge therapy. This procedure allowed the medical team to gain sufficient time to diagnose the type of infection and begin an etiological therapy.
authors.affiliation: Department of Health Science, Section of Anesthesiology and Intensive Care, University of Florence, Florence, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Villa
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: D'Alfonso
authors.forename: Paola
authors.initials: P
authors.lastname: Di Maggio
authors.forename: Margherita
authors.initials: M
authors.lastname: Berardi
authors.forename: Cosimo
authors.initials: C
authors.lastname: Chelazzi
authors.forename: Anna Lucia
authors.initials: AL
authors.lastname: Caldini
authors.forename: A Raffaele
authors.initials: AR
authors.lastname: De Gaudio
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis; D001856:Bone Marrow Examination; D003131:Combined Modality Therapy; D003354:Corynebacterium Infections / Q000175:diagnosis; D003422:Critical Care / Q000379:methods; D016207:Cytokines / Q000097:blood; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005189:False Positive Reactions; D005260:Female; D006440:Hemofiltration / Q000295:instrumentation*; D006801:Humans; D007896:Leishmaniasis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008567:Membranes, Artificial; D008875:Middle Aged; D008970:Molecular Weight; D010198:Pancytopenia / Q000209:etiology / Q000473:pathology; D010539:Permeability; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D000981:Antiprotozoal Agents; D016207:Cytokines; D008567:Membranes, Artificial; D014662:Vasoconstrictor Agents