Idiopathisches systemisches Capillary-leak-Syndrom (Clarkson-Syndrom)

Systemic capillary leak syndrome

The vascular endothelial barrier maintains intravascular volume and metabolic homeostasis. Although plasma fluids and proteins extravasate continuously from tissue microvasculature (capillaries, post-capillary venules), systemic vascular leakage increases in critical illness associated with sepsis, burns and trauma, among others, or in association with certain drugs or toxin exposures. Systemically dysregulated fluid homeostasis, which can lead to hypovolaemia, hypotensive shock and widespread tissue oedema, has been termed systemic capillary leak syndrome (SCLS) when overt secondary causes (for example, heart or liver failure) are excluded. In severe forms, SCLS is complicated by compartment syndrome in the extremities and multi-organ dysfunction syndrome due to shock and systemic hypoperfusion. The different forms of SCLS include idiopathic SCLS (ISCLS) and secondary SCLS (SSCLS), which can be triggered by several conditions, including certain infections and haematological malignancies. A subgroup of patients with ISCLS have monoclonal gammopathy-associated SCLS (also known as Clarkson disease), which is an ultra-rare and extreme form of ISCLS. ISCLS can be managed effectively with monthly prophylactic immunoglobulin therapy whereas SSCLS frequently does not recur once the underlying condition resolves or the offending agent is discontinued. Thus, differentiation between ISCLS, SSCLS and other causes of oedema is crucial for quick diagnosis and positive patient outcomes.

[Necrotizing myositis of the thigh : Cause or result of a systemic capillary leak syndrome?]

Infektionen des muskuloskeletalen Systems sind in der Unfallchirurgie mitunter die Krankheitsbilder, die Patienten am gravierendsten beeinträchtigen, Ärzte fachlich sowie Kliniken und das Gesundheitssystem ökonomisch herausfordern. Das systemische „Capillary-leak“-Syndrom (SCLS) ist ein seltenes idiopathisches Syndrom, welches auch bei harmlosen Infektionen fulminante lebensbedrohliche Verläufe provozieren kann. Neben einer übersichtlichen Darstellung des SCLS wird über einen betroffenen Patienten, der infolge einer instabilen Narbe eine nekrotisierende Myositis des Oberschenkels entwickelte, berichtet.