Compassionate use of the Seraph® 100 affinity blood filter in pediatric refractory streptococcal septic shock: a case report

Background Septic shock remains a major cause of morbidity and mortality in pediatric intensive care units, particularly in refractory cases unresponsive to standard therapy. Invasive Streptococcus pyogenes infection can lead to streptococcal toxic shock syndrome, characterized by severe inflammatory dysregulation and rapid clinical deterioration. Extracorporeal blood purification therapies, such as pathogen-binding hemoperfusion, have emerged as potential adjunctive treatments. Case Presentation We report the compassionate use of the Seraph® 100 Microbind® affinity blood filter in a previously healthy 7-year-old girl with refractory septic shock caused by invasive S. pyogenes . Despite early initiation of broad-spectrum antibiotics, immunoglobulins, vasopressors, mechanical ventilation, and continuous renal replacement therapy, the patient developed severe multiorgan dysfunction and persistent hemodynamic instability. Hemoperfusion was initiated 42 h after pediatric intensive care unit admission. Due to circuit instability, treatment was performed as a stand-alone 4-h session. Following hemoperfusion, a progressive reduction in vasoactive support and improvement in metabolic parameters, including lactate clearance, were observed within 24–48 h. The patient stabilized without requiring veno-arterial extracorporeal membrane oxygenation. However, early severe peripheral ischemia led to bilateral lower-limb amputations. The patient survived and was discharged after prolonged hospitalization. Conclusion In this case, pathogen-binding hemoperfusion with the Seraph® 100 filter was technically feasible and temporally associated with hemodynamic and metabolic improvement in refractory pediatric septic shock. Although causality cannot be established, these findings suggest a potential role for hemoperfusion as an adjunctive rescue therapy in selected cases. Further prospective studies are needed to determine its safety, optimal timing, and clinical efficacy in pediatric populations.