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Case report
Angiotensin II for the treatment of septic shock in a neutropenic patient with T-cell acute lymphoblastic leukaemia
  1. Albert D Bui1,2,
  2. Scott A Helgeson1,
  3. Pramod K Guru1 and
  4. Devang K Sanghavi1
  1. 1Critical Care, Mayo Clinic Florida, Jacksonville, Florida, USA
  2. 2Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio, USA
  1. Correspondence to Dr Devang K Sanghavi; Sanghavi.Devang{at}


Mortality remains high in septic shock with few new treatment options. Angiotensin II has been recently approved for use in septic shock due to promising results in the ATHOS-3 trial. However, patients with neutropenia were excluded in the trial. This patient population is becoming increasingly common in the intensive care unit as there is an increase in novel biologic therapies and stem cell transplantations for haematological and solid organ malignancies. We present a case of a patient with T-cell acute lymphoblastic leukaemia who received chemotherapy, resulting in neutropenia and septic shock. There was persistent hypotension despite initiating multiple conventional vasopressors. Angiotensin II was attempted with immediate improvement in the blood pressure which resulted in weaning of other vasopressors. This positive haemodynamic response suggests that angiotensin II can successfully be used in neutropenic patients without increasing the overall catecholamine burden of septic shock.

  • adult intensive care
  • oncology
  • pharmacokinetics

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  • Contributors DKS and SAH conceived the presented idea and conducted the study. ADB, SAH and DKS collected and interpreted the data. ADB and SAH wrote the manuscript in consultation with PKG and DKS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.