{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T21:07:42Z","timestamp":1784408862814,"version":"3.55.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Septic shock remains a major cause of morbidity and mortality in pediatric intensive care units, particularly in refractory cases unresponsive to standard therapy. Invasive\n                      <jats:italic>Streptococcus pyogenes<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      We report the compassionate use of the Seraph\u00ae 100 Microbind\u00ae affinity blood filter in a previously healthy 7-year-old girl with refractory septic shock caused by invasive\n                      <jats:italic>S. pyogenes<\/jats:italic>\n                      . 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\u201348 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this case, pathogen-binding hemoperfusion with the Seraph\u00ae 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1794907","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T05:20:29Z","timestamp":1776403229000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Compassionate use of the Seraph\u00ae 100 affinity blood filter in pediatric refractory streptococcal septic shock: a case report"],"prefix":"10.3389","volume":"14","author":[{"given":"Raul","family":"Montero-Yeboles","sequence":"first","affiliation":[{"name":"Pediatric Critical Care Unit, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Maria","family":"Saez-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Unit, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Ulloa-Santamaria","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Unit, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Diaz-Vico","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Unit, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jose","family":"Lorenzo-Montero","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care Unit, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Ruiz-Saez","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Reina Sofia Hospital","place":["Cordoba, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s00134-019-05878-6","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"46","author":"Weiss","year":"2020","journal-title":"Intensive Care Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/S1473-3099(05)70267-X","article-title":"The global burden of group A streptococcal diseases","volume":"5","author":"Carapetis","year":"2005","journal-title":"Lancet Infect Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1080\/21505594.2015.1134070","article-title":"Severe group A streptococcal infections","volume":"7","author":"Stevens","year":"2016","journal-title":"Virulence"},{"key":"B4","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1159\/000499520","article-title":"Management of acute kidney injury in patients with sepsis: role of extracorporeal blood purification therapies","volume":"47","author":"Ronco","year":"2019","journal-title":"Blood Purif"},{"key":"B5","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s13054-021-03586-4","article-title":"Hemofiltration with the seraph\u00ae 100 microbind\u00ae affinity blood filter in critically ill patients","volume":"25","author":"Kielstein","year":"2021","journal-title":"Crit Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1097\/MAT.0b013e3181c8b4f1","article-title":"Cytokines in blood from septic patients interact with surface-immobilized heparin","volume":"56","author":"Axelsson","year":"2010","journal-title":"ASAIO J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1159\/000535682","article-title":"Seraph\u00ae 100 microbind\u00ae affinity blood filter does not clear antibiotics: an analysis of antibiotic concentration data from PURIFY-OBS","volume":"53","author":"DeLuca","year":"2024","journal-title":"Blood Purif"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000524032","article-title":"Hemoperfusion with seraph 100 microbind affinity blood filter unlikely to require increased antibiotic dosing: a simulations study using a pharmacokinetic\/pharmacodynamic approach","volume":"51","author":"Selig","year":"2022","journal-title":"Blood Purif"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000528536","article-title":"First-time use of the seraph\u00ae 100 microbind\u00ae affinity blood filter in an adolescent patient with severe COVID\u221219 disease: a case report","volume":"13","author":"Merrill","year":"2023","journal-title":"Case Rep Nephrol Dial"},{"key":"B10","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1007\/s00467-023-06049-9","article-title":"Use of the seraph\u00ae 100 microbind\u00ae affinity blood filter in an adolescent patient with disseminated adenoviral disease","volume":"39","author":"Li","year":"2024","journal-title":"Pediatr Nephrol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e02380","DOI":"10.1016\/j.idcr.2025.e02380","article-title":"Seraph\u00ae 100 Microbind\u00ae utilization in immunocompromised toddler with adenovirus viremia in conjunction with continuous renal replacement therapy and extracorporeal membrane oxygenation","volume":"42","author":"Li","year":"2025","journal-title":"IDCases"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e70055","DOI":"10.1111\/petr.70055","article-title":"Seraph 100 microbind affinity blood filter for persistent pediatric BK virus nephropathy","volume":"29","author":"Harris","year":"2025","journal-title":"Pediatr Transplant"},{"key":"B13","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1056\/NEJMra1208623","article-title":"Severe sepsis and septic shock","volume":"369","author":"Angus","year":"2013","journal-title":"N Engl J Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1056\/NEJMcibr1404664","article-title":"Parallels between cancer and infectious disease","volume":"371","author":"Hotchkiss","year":"2014","journal-title":"N Engl J Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1794907\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T05:20:29Z","timestamp":1776403229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1794907\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":14,"alternative-id":["10.3389\/fped.2026.1794907"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1794907","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]},"article-number":"1794907"}}