Streptococcal toxic shock syndrome (STSS) is a rapidly progressive condition characterized by profound vasoplegic shock, cytokine storm, and multiorgan failure. Despite appropriate antimicrobial therapy and intensive care support, mortality remains high. Extracorporeal blood purification techniques such as hemoadsorption have emerged as adjunctive therapies to modulate dysregulated inflammation in severe septic shock.

We report a single case of refractory STSS complicated by severe acute respiratory distress syndrome (ARDS), acute kidney injury, and multi organ failure. The patient was managed with lung-protective mechanical ventilation, broad-spectrum antibiotics (meropenem, vancomycin, and clindamycin), hydrocortisone, and intravenous immunoglobulin. Due to refractory vasoplegic shock and hyperinflammation, continuous renal replacement therapy (CRRT) combined with hemoadsorption (Oxiris and HA330 cartridges) was initiated early as adjunctive extracorporeal blood purification therapy.

A hypertensive patient developed sudden hypotension following a recent pharyngeal infection and rapidly progressed to refractory septic shock. On ICU admission, the patient had severe ARDS (PaO₂/FiO₂ of 76), hyperdynamic shock requiring high-dose vasopressors (norepinephrine 1.1 µg/kg/min, epinephrine 0.17 µg/kg/min, vasopressin 0.03 UI/min), and multiorgan dysfunction. Laboratory findings showed markedly elevated IL-6 (1156 pg/mL), leukocytosis, acute kidney injury with anuria, and coagulopathy. After initiation of CRRT combined with hemoadsorption, a rapid clinical response was observed. IL-6 decreased from 1156 to 37 pg/mL within 48 hours. Lactate normalized, and vasopressors were discontinued by day 4. Oxygenation improved with PaO₂/FiO₂ increasing to >300. Renal function recovered with restoration of urine output. The patient was extubated after 6 days and discharged from ICU after 12 days in stable condition.

Early hemoadsorption combined with CRRT may be an effective adjunctive therapy in refractory streptococcal toxic shock syndrome. In this case, it was associated with rapid cytokine reduction, reversal of shock, multiorgan recovery, and favorable clinical outcome.