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A 43-year-old man was admitted to the intensive care unit and diagnosed with yellow fever. He presented with refractory bleeding, extreme hyperferritinemia, and multiple organ dysfunction syndrome, requiring renal replacement therapy, mechanical ventilation, and treatment with vasoactive drugs. Because the bleeding did not respond to fresh-frozen plasma administration, the patient received therapeutic plasma exchange, which was accompanied by a marked improvement of the clinical and biochemical parameters, including a significant decline in serum ferritin levels.
Authors’ addresses: Jaques Sztajnbok, Ceila Maria Sant’Ana Malaque, Camila Hitomi Nihei, Irene Faria Duayer, Zita Maria Leme Britto, Eduarda Gambini Beraldo, and Ralcyon Francis AzevedoTeixeira, Emílio Ribas Institute of Infectious Diseases, São Paulo, Brazil, E-mails: jaques.sztajnbok@gmail.com, ceila.malaque@emilioribas.sp.gov.br, camila.nihei@emilioribas.sp.gov.br, irene.duayer@emilioribas.sp.gov.br, zita.britto@emilioribas.sp.gov.br, eduardagambiniberaldo@gmail.com, and ralcyon.teixeira@emilioribas.sp.gov.br.