Treatment with meropenem, norepinephrine, intravenous immunoglobulin (IVIG), ganciclovir, and dexamethasone as well as high-flow nasal cannula (HFNC) placement were initiated. However, these approaches were ineffective as evidenced by sustained fever, hypoxemia, and hypotension. Chemotherapy was recommended for the patient, but her parents refused and asked for other therapeutic options. In view of the refractory state of HLH and her poor general condition, we next sought to achieve the immediate suppression of hypercytokinemia. Accordingly, we commenced blood purification. Plasma exchange (PE) was initially considered, but PE could not be performed owing to reduced plasma separator access owing to the coronavirus disease 2019 (COVID-19) pandemic. As such, we tried to use hemoadsorption (HA330-II perfusion column, Zhuhai Health Sails Biotechnology Co., Ltd., Zhuhai, China) in this patient. And informed written consent was obtained from the patient’ parent. Heparin sodium was employed for anticoagulation, and the patient was infused with platelets and fibrinogen prothrombin complex concentrate. On the second day of hospitalization, this hemoadsorption approach was implemented one time. After that, this hemoadsorption approach was implemented two more times over a three-day period. One day 1, she was in poor condition in terms of clinical symptoms and biochemical parameters. She also need high dose of norepinephrine to maintain the balance of cardiovascular function. On the fifth day, the patient exhibited significantly decreased levels of IL-6 (12.16 pg/ml), IL-8 (10.63 pg/ml), IL-10 (63.38 pg/ml), and IFN-γ (61.99 pg/ml) (Fig1). She was gradually weaned off norepinephrine treatment, and her fever disappeared while her total leukocyte and neutrophil counts increased. However, no significant improvement in liver function was observed (ALT 766 U/L, AST 1196 U/L, TBIL 170.54 umol/L, Fib 1.23 g/l), and inflammatory markers rebounded after hemoadsorption was terminated for two days, at which time the patient again developed a fever that reached as high as 40.0℃. At that time, her parents provided consent for chemotherapy (HLH-2004) treatment, which was initiated in combination with hemoadsorption.