Effective Management of Voriconazole-Induced Multi-Organ Dysfunction and Septic Shock Using CytoSorb-Integrated Continuous Renal Replacement Therapy: A Case Report

Abstract

Background: Drug-induced multi-organ dysfunction remains a significant clinical challenge, particularly when complicated by inflammatory cascades. Voriconazole (VRC) is a widely used antifungal agent, but its administration can occasionally result in serious systemic toxicity. In this case report, we describe the therapeutic application of Continuous Renal Replacement Therapy (CRRT) combined with CytoSorb hemoadsorption in managing voriconazole-associated toxicity. Case Presentation: A 34-year-old male presented with gastrointestinal and respiratory symptoms, hypotension, and evidence of multi-organ dysfunction following a two-week course of oral VRC for tinea corporis. His clinical condition deteriorated with involvement of multiple organ and septic shock, necessitating admission to the intensive care unit (ICU). Laboratory investigations indicated Acute kidney injury (AKI) and Cardiac impairment. CRRT with CytoSorb was initiated to reduce the inflammatory burden. The patient also required SLED and multiple transfusions of blood products. Management and Outcome: CytoSorb therapy was integrated into the CRRT circuit to target the suspected cytokine-driven inflammatory process. Over the course of treatment, the patient's hemodynamic and biochemical parameters improved gradually. The intervention appeared to help control systemic inflammation, supporting organ function, and improving overall clinical stability. Conclusion: This case highlights the potential role of CytoSorb hemoadsorption in combination with CRRT as an adjunctive approach for managing drug-induced multi-organ dysfunction. While further studies are needed, this case adds to the growing interest in hemoadsorption as a supportive measure in critical care.