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Hermida G, Alvarez-Nuño R, San Miguel-Izquierdo J, González-Quijada S, González-López TJ. Long Term Remission of Capillary Leak Syndrome Associated with Monoclonal Gammopathy with Progression to Multiple Myeloma After Autologous Stem Cell Transplantation: a Case Report and Review of the Literature. Oncol Ther 2024; 12:183-188. [PMID: 38306002 PMCID: PMC10881945 DOI: 10.1007/s40487-024-00263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Clarkson's disease is a very rare entity characterised by acute episodes of systemic oedema and severe hypotension associated with paraproteinaemia. Its classical treatment relies on methylxanthine combined with terbutaline. Although this prophylactic therapy reduces the mortality rate, relapses are frequent. Eighty percent of patients with Clarkson's disease present with monoclonal gammopathy of unknown significance (MGUS). The risk of progression to multiple myeloma is 1% per year. CASE DESCRIPTION Here, we present a 49-year-old woman who suffered multiple such episodes requiring treatment in the intensive care unit. Treatment with terbutaline and theophylline was ineffective. She was diagnosed with multiple myeloma (MM) 8 years after the first of these acute episodes. Antimyeloma treatment with bortezomib and dexamethasone was started, followed by autologous haemopoietic transplantation, with no further acute episodes since then. CONCLUSION Our case is, to our knowledge, unique because eradication of MM was followed by complete disappearance of acute episodes of capillary leakage. Our case report is also the first to support the use of bortezomib and dexamethasone in this setting. Furthermore, autologous peripheral blood progenitor cell transplantation consolidated the MM stringent complete remission achieving a very long progression-free survival (> 11 years) of both MM and Clarkson's disease.
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Affiliation(s)
- Gerardo Hermida
- Hematology Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Jesús San Miguel-Izquierdo
- Centro de Investigación Médica Aplicada, Centro de Investigación Biomédica en Red Cáncer, Clínica Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Druey KM, Eisch AR, Cunningham-Rundles C. Autologous hematopoietic stem cell transplantation in Clarkson disease. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:347-349. [PMID: 36309188 PMCID: PMC9839466 DOI: 10.1016/j.jaip.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/04/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Kirk M Druey
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Md.
| | - A Robin Eisch
- Lung and Vascular Inflammation Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Md
| | - Charlotte Cunningham-Rundles
- Department of Medicine, Department of Pediatrics, The Prism Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Moyon Q, Pineton de Chambrun M, Gousseff M, Mathian A, Hie M, Urbanski G, Verlicchi F, Faguer S, Dossier A, Lega JC, Riviere S, Saadoun D, Graveleau J, Lucchini-Lecomte MJ, Christides C, Le Moal S, Bibes B, Malizia G, Ruivard M, Blaison G, Alric L, Agard C, Soubrier M, Viallard JF, Levesque H, Rivard GE, Tieulie N, Hot A, Lovey PY, Hanslik T, Lhote F, Eble V, Álvarez Troncoso J, Aujayeb A, Quentric P, Taieb D, Cohen-Aubart F, Lambert M, Amoura Z. Intravenous Immunoglobulins Tapering and Withdrawal in Systemic Capillary Leak Syndrome (Clarkson Disease). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2889-2895. [PMID: 35870726 DOI: 10.1016/j.jaip.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The systemic capillary leak syndrome (SCLS), also known as Clarkson disease, is a very rare condition characterized by recurrent life-threatening episodes of vascular hyperpermeability in the presence of a monoclonal gammopathy. Extended intravenous immunoglobulin (IVIG) treatment is associated with fewer recurrences and improved survival, but the optimal treatment dosage and duration remain unknown. OBJECTIVE We aim to evaluate the safety of IVIG tapering and withdrawal in patients with SCLS. METHODS We conducted a retrospective multicenter study including all adult patients with monoclonal gammopathy-associated SCLS from the EurêClark registry who received at least 1 course of IVIG. The primary end point was overall survival according to IVIG withdrawal. RESULTS Fifty-nine patients of mean ± SD age 51 ± 13 years were included. Overall cumulative probabilities of 2-, 5-, 10- and 15-year survival were 100%, 85%, 72%, 44%, respectively. The IVIG was withdrawn at least once in 18 patients (31%; W+ group) and never in 41 patients (69%; W- group). Cumulative probabilities of 10-year survival in W+ versus W- groups were 50% and 83% (log rank test, P = .02), respectively. Relapse rate and the median number of relapses in the W+ versus the W- groups were 72% versus 58% (P = 0.3) and 2.5 (0.3-4) versus 1 (0-2) (P = .03), respectively. The IVIG tapering was not statistically associated with increased person-year incidence of attacks using a mixed linear model. CONCLUSIONS The IVIG withdrawal was associated with increased mortality and higher rate of recurrence in SCLS patients. The IVIG tapering might be cautiously considered in stable SCLS patients.
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Affiliation(s)
- Quentin Moyon
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France.
| | - Marie Gousseff
- Service de médecine interne, Centre Hospitalier (CH) Bretagne Atlantique, Vannes, France
| | - Alexis Mathian
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Miguel Hie
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d'Immunologie Clinique, Centre Hospitalier Universitaire (CHU) d'Angers, Angers, France
| | | | - Stanislas Faguer
- Département de Néphrologie Et Transplantation D'organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, équipe 12), CHU de Toulouse, Toulouse, France
| | - Antoine Dossier
- Service de médecine interne, CHU Bichat, APHP, Paris, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, CHU Lyon Sud, Pierre-Bénite, Lyon; Univ Lyon 1, UMR CNRS 5558 Laboratoire de Biologie et Biométrie Evolutive
| | - Sophie Riviere
- Service de médecine interne, Hôpital S(t)-Eloi, CHRU, Montpellier, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology- Immunopathology-Immunotherapy (I3), Paris, France
| | | | | | | | | | | | | | - Marc Ruivard
- Service de médecine interne, Hôpital d'Estaing, CHU de Clermont-Ferrand, France
| | - Gilles Blaison
- Service de médecine interne, Hôpital Pasteur, Colmar, France
| | - Laurent Alric
- Service de médecine interne, Pôle digestif, CHU Rangueil, Toulouse 3 University, Toulouse, France
| | - Christian Agard
- Nantes Université, CHU Nantes, service de médecine interne, F-44000 Nantes, France
| | - Martin Soubrier
- Service de rhumatologie, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, France
| | | | - Hervé Levesque
- Service de médecine interne, Normandie Université, UNIROUEN, 76031 Rouen, France
| | | | | | - Arnaud Hot
- Service de médecine interne, CHU Edouard Herriot, Lyon, France
| | | | - Thomas Hanslik
- Université Versailles Saint Quentin, APHP, CHU Ambroise Paré, Service de médecine interne, Boulogne-Billancourt, France
| | - François Lhote
- Service de médecine interne, Hôpital Delafontaine, Saint-Denis, France
| | | | - Jorge Álvarez Troncoso
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Newcastle, UK
| | - Paul Quentric
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Dov Taieb
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France; Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France
| | - Zahir Amoura
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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Inoue M, Yasue Y, Kobayashi Y, Sugiyama Y. Systemic capillary leak syndrome (SCLS) after receiving BNT162b2 mRNA COVID-19 (Pfizer-BioNTech) vaccine. BMJ Case Rep 2022; 15:e248927. [PMID: 35292552 PMCID: PMC8928276 DOI: 10.1136/bcr-2022-248927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/03/2022] Open
Abstract
Systemic capillary leak syndrome (SCLS), also known as Clarkson's disease, is a rare disorder of unknown aetiology. Since SCLS was first described in 1960, fewer than 500 cases have been reported. SCLS is diagnosed by the classic triad of hypotension, haemoconcentration and hypoalbuminaemia resulting from fluid extravasation. Some reports show that SCLS may sometimes occur as a side effect of adenoviral vector COVID-19 vaccines, although there is only one report (two cases) of SCLS after receiving a messenger RNA vaccine. Survival rates for SCLS are very poor without treatment, so it is crucial for clinicians to recognise this disorder. A middle-aged woman who presented with generalised malaise and anasarca after receiving the BNT162b2 COVID-19 vaccine was diagnosed with SCLS. Treatment with methylprednisolone and intravenous immunoglobulin was commenced and her symptoms resolved. We expect that this case report will add to the existing literature on this rare disorder and the side effects of vaccinations.
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Affiliation(s)
| | - Yu Yasue
- Nephrology, Tajimi Hospital, Tajimi, Japan
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Brewington BY, Kondapalli S, Kothari SS, Parikh SV, Cebulla CM. Choroidal Effusion Mimicking Uveal Melanoma: A Novel Presentation of Idiopathic Systemic Capillary Leak Syndrome. Ocul Oncol Pathol 2022; 7:390-395. [PMID: 35087815 DOI: 10.1159/000512765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Idiopathic systemic capillary leak syndrome (ISCLS, also known as Clarkson's disease) is a rare medical condition characterized by episodes of capillary endothelial cell dysfunction with leakage of fluid into the interstitial space resulting in severe hypotension, hemoconcentration, hypoalbuminemia, and generalized edema. Each episode can result in multiorgan failure due to systemic hypoperfusion. Case Presentation We report a case of uveal effusion, mimicking uveal melanoma, associated with ISCLS following viral infection. A 74-year-old white male was evaluated in our ocular tumor clinic for a large intraocular mass in the right eye concerning for choroidal melanoma. We completed a review of the literature and list clinical recommendations for these cases. ISCLS, although rare, was a significant diagnostic consideration in this patient. Due to the high mortality rate of this condition, accurate diagnosis and prompt treatment was critical. We hypothesize that the mechanism of choroidal effusion development was due to reduced oncotic pressure from rapid decrease in serum albumin. Increased permeability of choroidal capillaries may be an additional mechanism leading to uveal effusion. Conclusion With treatment, the patient had complete resolution of his choroidal effusion with no recurrence of his ISCLS. Further research should be considered on the role of viral infections in the pathogenesis of ISCLS.
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Affiliation(s)
- Beatrice Y Brewington
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Srinivas Kondapalli
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Shaili S Kothari
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Samir V Parikh
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Colleen M Cebulla
- Department of Ophthalmology and Visual Sciences, Havener Eye Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Sharie AHA, Zu’bi YOA, Sharie SA, Baydoun HA, Atawneh FH, Alshari O, Albals D. Systemic capillary leak syndrome following granulocyte colony-stimulating factor therapy in a T-lymphoblastic leukemia/lymphoma patient: a case report. MEMO 2022; 15:143-148. [PMID: 35096191 PMCID: PMC8785001 DOI: 10.1007/s12254-021-00789-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/03/2021] [Indexed: 06/02/2023]
Abstract
Introduction Systemic capillary leak syndrome (SCLS) is a rare and often fatal clinical entity used to describe a generalized increase in vascular permeability leading to fluid extravasation toward the interstitial compartment. SCLS could be an idiopathic disease or secondary to infections, malignancies or drugs. Case We present a case of presumably granulocyte colony-stimulating factor (G-CSF)-induced SCLS in a 21-year-old man diagnosed with T‑lymphoblastic leukemia/lymphoma. He received the 6th cycle (part B) of the hyper-CVAD chemotherapeutic regimen followed by the initiation of neutropenic fever prophylaxis protocol which included antibiotics and G‑CSF. In a course of hours, the patient became dyspneic, hypotensive, and edematous which required intensive care unit admission and was stabilized accordingly. In the following days the patient's anasarca progressively increased which was associated with hypoalbuminemia, hypotension and anemia with pericardial and bilateral plural effusions. As a diagnosis of exclusion augmented by the acuity of such clinical event, observed concomitantly with the administration of the prophylaxis protocol, the suspicion of G‑CSF-induced SCLS was established. Consequently, G‑CSF was discontinued and treatment with dexamethasone and intravenous immunoglobulins (IVIG) was started. The patient's condition improved significantly illustrated by hemodynamic stability in addition to improvement regarding the anasarca, hypoalbuminemia, and anemia. Follow-up scans suggest resolution of the pericardial and plural effusions. Conclusion SCLS remains a serios and potentially fatal complication of G‑CSF administration which should be taken into consideration, since such medication is widely utilized in oncology wards.
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Affiliation(s)
- Ahmed H. Al Sharie
- Faculty of Medicine, Jordan University of Science and Technology, 22110 Irbid, Jordan
| | - Yazan O. Al Zu’bi
- Faculty of Medicine, Jordan University of Science and Technology, 22110 Irbid, Jordan
| | - Sarah Al Sharie
- Faculty of Medicine, Yarmouk University, 22110 Irbid, Jordan
| | - Hawra A. Baydoun
- Faculty of Medicine, Jordan University of Science and Technology, 22110 Irbid, Jordan
| | - Farah H. Atawneh
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Osama Alshari
- Division of Oncology, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box: 3030, 22110 Irbid, Jordan
| | - Dima Albals
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Yarmouk University, Irbid, Jordan
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Dogan S, Kıvrak-Salim D, Ureyen I, Iltar U, Kurtoğlu E. Systemic capillary leakage syndrome. Int J Gynecol Cancer 2021; 31:1602-1605. [PMID: 34872940 DOI: 10.1136/ijgc-2021-003034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Selen Dogan
- Department of Gynecologic Oncology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Derya Kıvrak-Salim
- Department of Medical Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Isin Ureyen
- Department of Gynecologic Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Utku Iltar
- Department of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Erdal Kurtoğlu
- Department of Hematology, Antalya Training and Research Hospital, Antalya, Turkey
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Consider systemic capillary leak syndrome in monoclonal gammopathy with shock. Ann Med Surg (Lond) 2021; 72:103013. [PMID: 34824836 PMCID: PMC8604768 DOI: 10.1016/j.amsu.2021.103013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance The cappilary leacking syndrome is a very rare disease that can be idiopathic (clarkson syndrome) or secondary to other pathologys. Case presentation We report a case of 37-year-old women who was admitted in the emergency room for a hemodynamic shock of neither cardiac nor septic cause, and the patient wasn't presenting any bleeding. The investigations showed that the diagnosis was a Clarkson syndrome crisis and the patient was having supportive treatment containing fluid therapy, vasoactive drugs, and ECMO. And died after 48h of hospitalization. Clinical discussion the cappilary leacking syndrome is a very fatal affection, its physiopathologis remains unknown. It evoluate by crisis made by hypotension and anasarca, in severe cases it is presented as fatal hypovolemic schock. Biological investigations show hemoconcentration associated with hypoalbunemia which is pathognomonic of the disease. The treatment is essentially based on crisis treatment support by fluid therapy, vasoactives drugs, some practicien report the use of theophilyn for prevention but without any proven efficiency. Conclusion For all this reasons we are in the obligation of investing in fundamental studies to better understand this fatal disease. The cappilary leacking syndrome is a very rare disease. The physiopathology of cappilary leck syndrom remains unknown. It evoluate by crisis made by hypotension and anasarca, in severe cases it is presented as fatal hypovolemic schock. Hemoconcentration associated with hypoalbunemia is pathognomonic of the disease.
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Neo YN, Sobti M, Zambarakji H. Bilateral simultaneous non-arteritic ischaemic optic neuropathy: a rare complication of idiopathic systemic capillary leak syndrome (SCLS). BMJ Case Rep 2021; 14:14/5/e242847. [PMID: 33947680 PMCID: PMC8098958 DOI: 10.1136/bcr-2021-242847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of bilateral symmetrical superior visual field defects in a 72-year-old man first reported during the recovery from systemic capillary leak syndrome (SCLS). During the acute illness, he required extensive and prolonged fluid replacement and mechanical ventilation for severe hypotension, shock and multiorgan dysfunction. His visual field defect and optic nerve changes were consistent with a diagnosis of ischaemic optic neuropathy. These remained unchanged over 3 years and he retained excellent 6/7.5 visual acuity bilaterally. We hypothesised the mechanism of bilateral segmental infarction of the optic nerve head to be caused by the hypercoagulable and hypovolaemic state, in addition to pre-existing vascular disease and hypertension. This case highlights the importance of including optic nerve examination in the management plan of SCLS, particularly in individuals with underlying vascular risk factors.
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Affiliation(s)
- Yan Ning Neo
- Ophthalmology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Manvi Sobti
- Ophthalmology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Hadi Zambarakji
- Ophthalmology Department, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Bichon A, Carvelli J, Bourenne J, Gainnier M, Harlé JR, Schleinitz N. [Idiopathic systemic capillary leak syndrome: 2 cases with misleading presentation]. Rev Med Interne 2021; 42:660-664. [PMID: 33846036 DOI: 10.1016/j.revmed.2021.03.325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/10/2021] [Accepted: 03/21/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Idiopathic systemic capillary leak syndrome (ISCLS) also known as Clarkson syndrome is a rare and sudden life-threatening entity. Three consecutive phases are described. A first non-specific prodromal phase often manifests as "flu-like" symptoms and precedes capillary leak phase with major hypovolemic and distributive shock leading to serious and frequent multiorgan dysfunction syndrome (MODS). Severe hypovolemia contrasts with edema, and hemoconcentration with hypoalbuminemia. ISCLS is characterized by these two clinical and biological paradoxes. Subsequent recovery phase exhibits organ function restoration along with interstitial/intravascular volumes normalization. The latter occurs spontaneously and systematically in patients surviving from leak phase. OBSERVATIONS We report here two ISCLS cases admitted in intensive care unit (ICU) both enhancing initial misdiagnosis possibly lowering prognosis and outcome. Our first 28-year-old female patient was admitted for « polycythemia vera » although hemoconcentration was attributable to hypovolemia. She presented circulatory arrest during the second bloodletting session and complicated with MODS. In and out ICU favorable outcome was noted on intravenous immunoglobulin therapy. A second 57-year-old male patient was admitted in ICU for severe "myositis" (myalgia and rhabdomyolysis) although rectified diagnosis retained compartment syndrome (muscular severe edema following capillary leak). Rapid and refractory hypovolemic shock appeared with subsequent MODS leading to death. CONCLUSION ISCLS pathophysiology remains unknown but certainly implies transitory endothelial dysfunction. Impossibility of randomized controlled trial for this exceptional disease led to based-on-experience therapeutic guidelines implying symptomatic care (cardiac output surveillance, nephroprotection, prudent fluid intake, prudent vasoactive amine use) and specific therapies (intravenous aminophylline during severe flares). Although enhancing controversial and even deleterious effects during the acute phase, polyvalent immunoglobulins are effective for relapse prevention. Syndromic diagnosis is difficult, but its precocious finding constitutes a key-element in better outcome before organ failure.
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Affiliation(s)
- A Bichon
- Service de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France; Université d'Aix-Marseille, Marseille, France.
| | - J Carvelli
- Service de réanimation médicale, hôpital de la Timone, AP-HM, Marseille, France; Université d'Aix-Marseille, Marseille, France
| | - J Bourenne
- Service de réanimation médicale, hôpital de la Timone, AP-HM, Marseille, France; Université d'Aix-Marseille, Marseille, France
| | - M Gainnier
- Service de réanimation médicale, hôpital de la Timone, AP-HM, Marseille, France; Université d'Aix-Marseille, Marseille, France
| | - J-R Harlé
- Service de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France; Université d'Aix-Marseille, Marseille, France
| | - N Schleinitz
- Service de médecine interne, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France; Université d'Aix-Marseille, Marseille, France
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12
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Leibovich-Nassi I, Reshef A. The Enigma of Prodromes in Hereditary Angioedema (HAE). Clin Rev Allergy Immunol 2021; 61:15-28. [PMID: 33534063 DOI: 10.1007/s12016-021-08839-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 11/30/2022]
Abstract
A prodrome is a premonitory set of signs and symptoms indicating the onset of a disease. Prodromes are frequently reported by hereditary angioedema (HAE) patients, antedating attacks by a few hours or even longer. In some studies, high incidence of prodromes was reported by patients, with considerable number being able to predict oncoming attacks. Regrettably, prodromes have never received a consensual definition and have not been properly investigated in a systematic fashion. Therefore, their nature remains elusive and their contribution to the diagnosis and treatment of disorders is uncertain. The term "prodrome," as used in various pathologies, denotes different meanings, timing, and duration, so it may not be equally suitable for all clinical situations. Perception of a prodrome is unique for each individual patient depending on self-experience. As modern drugs delegate the administration decision to the patients, early detection of a developing attack may help mitigate its severity and allow deployment of appropriate therapy. New diagnostic instruments were recently developed that can assist in defining the attributes of prodromes and their association with attacks. We will review the prodrome phenomenon as exhibited in certain clinical situations, with an emphasis on prodromes of HAE.
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Affiliation(s)
- Iris Leibovich-Nassi
- Barzilai University Medical Center, Ashkelon, Israel
- Department of Nursing, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Reshef
- Barzilai University Medical Center, Ashkelon, Israel.
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Rajan R, Kapoor N, Asha HS, Paul TV, Thomas N. Idiopathic systemic capillary leak syndrome - An often missed diagnosis. Trop Doct 2020; 51:246-248. [PMID: 33349162 DOI: 10.1177/0049475520979299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Idiopathic systemic capillary leak syndrome (ISCLS) is a potentially fatal disorder characterised by 'attacks' of varying intensity of hypovolemic shock in association with haemoconcentration and hypoalbuminaemia. It is a disease of exclusion, and the severity of attacks may mimic sepsis at presentation. We report a case of a lady with recurrent attacks of ISCLS with at least two life-threatening episodes, having been treated elsewhere as a case of steroid insufficiency. The diagnosis is often challenging, and treatment of an acute episode involves the judicious use of fluids and vasopressors, as required. Prophylaxis to prevent further attacks is of varied success.
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Affiliation(s)
- Remya Rajan
- Senior PG Registrar, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - Nitin Kapoor
- Associate Professor, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - Hesarghatta S Asha
- Professor, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - Thomas V Paul
- Professor, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Professor, Department of Endocrinology and Metabolism, Christian Medical College, Vellore, India
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Ezine E, Pedailles S, Dompmartin A, Morice C. Syndrome de fuite capillaire observé sous acitrétine : un cas et revue de la littérature. Ann Dermatol Venereol 2020; 147:535-541. [DOI: 10.1016/j.annder.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/26/2020] [Accepted: 04/14/2020] [Indexed: 10/23/2022]
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Keskin H, Cadirci K, Demirkazik A, Akbulut H, Yalcin B. Following Chemotherapy: Serum Cytokine (Tumor Necrosis Factor, Interleukin-2, Interleukin-11), Immunoglobulin, Complement, Vascular Endothelial Growth Factor Levels, and the Systemic Symptoms like Capillary Leak Syndrome. BIOMARKERS IN CANCER 2019; 11:1179299X19854447. [PMID: 31217693 PMCID: PMC6558530 DOI: 10.1177/1179299x19854447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/08/2019] [Indexed: 11/17/2022]
Abstract
Several problems such as myalgia, arthralgia, fever, dyspnea, generalized edema, and pleural effusion can occur in cancer patients following the chemotherapy, especially at the first cycle of the first chemotherapy treatment. Although it is assumed that some cytokines are associated with the development of these symptoms and signs, their pathophysiology has not been discovered completely yet. They are usually mild, but they may rarely progress to the severe stage of "Systemic Capillary Leak Syndrome" with a high mortality rate. The objective of this study was to investigate the association between the serum levels of interleukin-2 (IL-2), interleukin-11 (IL-11), tumor necrosis factor alpha (TNF-α), vascular endothelial growth factor (VEGF), and these symptoms and signs. A total of 44 cancer patients who had neither heart, lung, liver, renal, or thyroid disease were recruited into this study. Their symptoms and signs were examined and questioned before the first cycle of the first chemotherapy treatment and the 24 h after this chemotherapy. All participant's serum samples were taken, and the VEGF, TNF, IL-2, and IL-11 levels were studied. There was no association between the chemotherapeutic drugs, and the symptoms and signs such as edema, dyspnea, coughing, and flu-like symptoms. There was a significant decrease in IL-11 levels in the other treatment group compared with the group receiving paclitaxel, docetaxel, gemcitabine, and vinorelbine in the first day following chemotherapy (P = .006). However, no relation was observed between the symptoms and signs, the response to the chemotherapy, and the serum levels of VEGF, TNF, IL-2, and IL-11. These symptoms and life-threatening syndrome have been a current topic between the clinicians. Although some drugs and mediators are accused, its pathophysiology has not been discovered completely yet. In this study, we could not detect any association between the symptoms, signs, and the cytokine levels following the chemotherapy.
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Affiliation(s)
- Havva Keskin
- Department of Internal Medicine,
Istanbul Medeniyet University Training and Research Hospital, Istanbul, Turkey
| | - Kenan Cadirci
- Department of Internal Medicine, Erzurum
Regional Training and Research Hospital, Erzurum, Turkey
| | - Ahmet Demirkazik
- Department of Medical Oncology, Faculty
of Medicine, University of Ankara, Ankara, Turkey
| | - Hakan Akbulut
- Department of Medical Oncology, Faculty
of Medicine, University of Ankara, Ankara, Turkey
| | - Bulent Yalcin
- Department of Medical Oncology, Faculty
of Medicine, University of Yildirim Beyazit and Atatürk Training and Research
Hospital, Ankara, Turkey
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Baloch NUA, Bikak M, Rehman A, Rahman O. Recognition and management of idiopathic systemic capillary leak syndrome: an evidence-based review. Expert Rev Cardiovasc Ther 2018; 16:331-340. [PMID: 29564922 DOI: 10.1080/14779072.2018.1456920] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Idiopathic systemic capillary leak syndrome (SCLS) is a unique disorder characterized by episodes of massive systemic leak of intravascular fluid leading to volume depletion and shock. A typical attack of SCLS consists of prodromal, leak and post-leak phases. Complications, such as compartment syndrome and pulmonary edema, usually develop during the leak and post-leak phases respectively. Judicious intravenous hydration and early use of vasopressors is the cornerstone of management in such cases. Areas covered: The purpose of the present review is to provide an up-to-date, evidence-based review of our understanding of SCLS and its management in the light of currently available evidence. COMMENTARY Idiopathic SCLS was first described in 1960 and, since then, more than 250 cases have been reported. A large number of cases have been reported over the past one decade, most likely due to improved recognition. In the acute care setting, most patients with SCLS are managed as per the Surviving Sepsis guidelines and receive aggressive volume resuscitation - which is not the optimal management strategy for such patients. There is a need to raise awareness amongst physicians and clinicians in order to improve recognition of this disorder and ensure its appropriate management.
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Affiliation(s)
- Noor Ul-Ain Baloch
- a Resident Physician, Department of Medicine, Rutgers-New Jersey Medical School , University Hospital , Newark , NJ , USA
| | - Marvi Bikak
- b Department of Critical Care Medicine , Indiana University Health Methodist Hospital , Indianapolis , IN , USA
| | - Abdul Rehman
- b Department of Critical Care Medicine , Indiana University Health Methodist Hospital , Indianapolis , IN , USA
| | - Omar Rahman
- b Department of Critical Care Medicine , Indiana University Health Methodist Hospital , Indianapolis , IN , USA
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Bressan AL, Pereira D, Medeiros PM, Carneiro S, Azulay-Abulafia L. How relevant are vascular endothelial growth factor and intercellular adhesion molecule in the systemic capillary leak syndrome of psoriasis? An Bras Dermatol 2018; 92:826-829. [PMID: 29364440 PMCID: PMC5786398 DOI: 10.1590/abd1806-4841.20175994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/24/2016] [Indexed: 12/26/2022] Open
Abstract
Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.
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Affiliation(s)
- Aline Lopes Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | | | - Paula Mota Medeiros
- Department of Dermatology, Centro Universitário Cesmac - Maceió (AL), Brazil.,Department of Dermatology, Centro Universitário Tiradentes (Unit) - Maceió (AL), Brazil
| | - Sueli Carneiro
- Department of Dermatology, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro (RJ), Brazil
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Intravenous Immunoglobulins Improve Survival in Monoclonal Gammopathy-Associated Systemic Capillary-Leak Syndrome. Am J Med 2017; 130:1219.e19-1219.e27. [PMID: 28602874 DOI: 10.1016/j.amjmed.2017.05.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/28/2017] [Accepted: 05/09/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Monoclonal gammopathy-associated systemic capillary-leak syndrome, also known as Clarkson disease, is a rare condition characterized by recurrent life-threatening episodes of capillary hyperpermeability in the context of a monoclonal gammopathy. This study was conducted to better describe the clinical characteristics, natural history, and long-term outcome of monoclonal gammopathy-associated systemic capillary-leak syndrome. METHODS We conducted a cohort analysis of all patients included in the European Clarkson disease (EurêClark) registry between January 1997 and March 2016. From diagnosis to last follow-up, studied outcomes (eg, the frequency and severity of attacks, death, and evolution toward multiple myeloma) and the type of preventive treatments administered were monitored every 6 months. RESULTS Sixty-nine patients (M/F sex ratio 1:1; mean ± SD age at disease onset 52 ± 12 years) were included in the study. All patients had monoclonal gammopathy of immunoglobulin G type, with kappa light chains in 47 (68%). Median (interquartile range) follow-up duration was 5.1 (2.5-9.7) years. Twenty-four patients (35%) died after 3.3 (0.9-8) years. Fifty-seven (86%) patients received at least one preventive treatment, including intravenous immunoglobulins (IVIg) n = 48 (73.8%), theophylline n = 22 (33.8%), terbutaline n = 22 (33.8%), and thalidomide n = 5 (7.7%). In the 65 patients with follow-up, 5- and 10-year survival rates were 78% (n = 35) and 69% (n = 17), respectively. Multivariate analysis found preventive treatment with IVIg (hazard ratio 0.27; 95% confidence interval, 0.10-0.70; P = .007) and terbutaline (hazard ratio 0.35; 95% confidence interval, 0.13-0.96; P = .041) to be independent predictors of mortality. CONCLUSIONS We describe the largest cohort to date of patients with well-defined monoclonal gammopathy-associated systemic capillary-leak syndrome. Preventive treatment with IVIg was the strongest factor associated with survival, suggesting the use of IVIg as the first line in prevention therapy.
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Sobral L, Ângelo AC, Caetano A, Rodeia J, Rosa I. Bilateral Ankle Fusion in Leak Syndrome Induced Deformity: A Case Report. J Orthop Case Rep 2017; 7:52-56. [PMID: 28819603 PMCID: PMC5553837 DOI: 10.13107/jocr.2250-0685.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Systemic capillary leak syndrome (SCLS) is a rare condition of unknown etiology defined by sudden episode of hypotension, high hematocrit, and low serum protein concentration due to capillary hyperpermeability. Several treatments have been published for this pathology and eventual compartment syndrome but not for the disabling consequences. This clinical case highlights the negative orthopedic consequences of a severe systemic attack and reports a subsequent deformity treatment option that resulted in the patient quality of life improvement. To our knowledge, orthopedic surgery for SCLS induced foot and ankle deformity is presented for the first time. Case Report: A 40-year-old Caucasian female patient was referred to our institution for bilateral foot and ankle deformity after compartment syndrome during SCLS attack. She presented a bilateral rigid equino-cavo-varus-adductus deformity causing walk impairment. Bilateral ankle fusion by retrograde nailing was performed in a two-staged procedure. Rigid claw toes were also surgically addressed in an additional procedure. Radiologically, apparent ankle fusion occurred at 3 months post-operative in both sides. Deformity correction allowed the patient to regain walking capacity. A right ankle tibiotalar failed arthrodesis was noticed at 24 months post-operative. Prophylactic human immunoglobulin therapy was initiated after the last surgery with no recurrent attack registered during the 38 months follow-up period. Conclusion: Bilateral ankle fusion improved this patient quality of life by restituting walking capacity and lowering the probability of lower limb deformity related ulcers and infections. Major and minor complications are also discussed. This report contributes to the global knowledge about this syndrome and elicits the importance of the induced deformities surgical correction.
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Affiliation(s)
- Luis Sobral
- Department of Traumatology and Orthopaedics, São Francisco Xavier Hospital, Estrada do Forte do Alto do Duque 1449-005, Lisboa, Portugal
| | - Ana C Ângelo
- Department of Traumatology and Orthopaedics, São Francisco Xavier Hospital, Estrada do Forte do Alto do Duque 1449-005, Lisboa, Portugal
| | - Afonso Caetano
- Department of Traumatology and Orthopaedics, São Francisco Xavier Hospital, Estrada do Forte do Alto do Duque 1449-005, Lisboa, Portugal
| | - Joaquim Rodeia
- Department of Traumatology and Orthopaedics, São Francisco Xavier Hospital, Estrada do Forte do Alto do Duque 1449-005, Lisboa, Portugal
| | - Isabel Rosa
- Department of Traumatology and Orthopaedics, São Francisco Xavier Hospital, Estrada do Forte do Alto do Duque 1449-005, Lisboa, Portugal
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Abstract
OBJECTIVE Systemic capillary-leak syndrome is a very rare cause of recurrent hypovolemic shock. Few data are available on its clinical manifestations, laboratory findings, and outcomes of those patients requiring ICU admission. This study was undertaken to describe the clinical pictures and ICU management of severe systemic capillary-leak syndrome episodes. DESIGN, SETTING, PATIENTS This multicenter retrospective analysis concerned patients entered in the European Clarkson's disease (EurêClark) Registry and admitted to ICUs between May 1992 and February 2016. MEASUREMENTS AND MAIN RESULTS Fifty-nine attacks occurring in 37 patients (male-to-female sex ratio, 1.05; mean ± SD age, 51 ± 11.4 yr) were included. Among 34 patients (91.9%) with monoclonal immunoglobulin G gammopathy, 20 (58.8%) had kappa light chains. ICU-admission hemoglobin and proteinemia were respectively median (interquartile range) 20.2 g/dL (17.9-22 g/dL) and 50 g/L (36.5-58.5 g/L). IV immunoglobulins were infused (IV immunoglobulin) during 15 episodes (25.4%). A compartment syndrome developed during 12 episodes (20.3%). Eleven (18.6%) in-ICU deaths occurred. Bivariable analyses (the 37 patients' last episodes) retained Sequential Organ-Failure Assessment score greater than 10 (odds ratio, 12.9 [95% CI, 1.2-140]; p = 0.04) and cumulated fluid-therapy volume greater than 10.7 L (odds ratio, 16.8 [1.6-180]; p = 0.02) as independent predictors of hospital mortality. CONCLUSIONS We described the largest cohort of severe systemic capillary-leak syndrome flares requiring ICU admission. High-volume fluid therapy was independently associated with poorer outcomes. IV immunoglobulin use was not associated with improved survival; hence, their use should be considered prudently and needs further evaluation in future studies.
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Diagnostic et prise en charge du syndrome de fuite capillaire idiopathique (SFCI). MEDECINE INTENSIVE REANIMATION 2017. [DOI: 10.1007/s13546-017-1275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siddall E, Khatri M, Radhakrishnan J. Capillary leak syndrome: etiologies, pathophysiology, and management. Kidney Int 2017; 92:37-46. [PMID: 28318633 DOI: 10.1016/j.kint.2016.11.029] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/25/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023]
Abstract
In various human diseases, an increase in capillary permeability to proteins leads to the loss of protein-rich fluid from the intravascular to the interstitial space. Although sepsis is the disease most commonly associated with this phenomenon, many other diseases can lead to a "sepsis-like" syndrome with manifestations of diffuse pitting edema, exudative serous cavity effusions, noncardiogenic pulmonary edema, hypotension, and, in some cases, hypovolemic shock with multiple-organ failure. The term capillary leak syndrome has been used to describe this constellation of disease manifestations associated with an increased capillary permeability to proteins. Diseases other than sepsis that can result in capillary leak syndrome include the idiopathic systemic capillary leak syndrome or Clarkson's disease, engraftment syndrome, differentiation syndrome, the ovarian hyperstimulation syndrome, hemophagocytic lymphohistiocytosis, viral hemorrhagic fevers, autoimmune diseases, snakebite envenomation, and ricin poisoning. Drugs including some interleukins, some monoclonal antibodies, and gemcitabine can also cause capillary leak syndrome. Acute kidney injury is commonly seen in all of these diseases. In addition to hypotension, cytokines are likely to be important in the pathophysiology of acute kidney injury in capillary leak syndrome. Fluid management is a critical part of the treatment of capillary leak syndrome; hypovolemia and hypotension can cause organ injury, whereas capillary leakage of administered fluid can worsen organ edema leading to progressive organ injury. The purpose of this article is to discuss the diseases other than sepsis that produce capillary leak and review their collective pathophysiology and treatment.
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Affiliation(s)
- Eric Siddall
- Columbia University Medical Center, New York, New York, USA
| | - Minesh Khatri
- Winthrop University Hospital, Mineola, New York, USA
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Guffroy A, Dervieux B, Gravier S, Martinez C, Deibener-Kaminsky J, Hachulla E, Michel M, Weber JC, Korganow AS, Arnaud L, Gottenberg JE, Sibilia J. Systemic capillary leak syndrome and autoimmune diseases: A case series. Semin Arthritis Rheum 2017; 46:509-512. [DOI: 10.1016/j.semarthrit.2016.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 12/01/2022]
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Udayabhaskaran V, Arun Thomas ET, Shaji B. Capillary Leak Syndrome Following Snakebite Envenomation. Indian J Crit Care Med 2017; 21:698-702. [PMID: 29142382 PMCID: PMC5672676 DOI: 10.4103/ijccm.ijccm_41_17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Capillary leak syndrome is a unique complication that follows Russell's viper envenomation. This syndrome has a very high fatality rate and is characterized by parotid swelling, chemosis, periorbital edema, hypotension, albuminuria, hypoalbuminemia, and hemoconcentration. This syndrome is frequently recognized from the southern parts of India, especially from the state of Kerala. It has been postulated that a vascular apoptosis inducing component of Russell's viper venom that is not neutralized by the commercially available anti-snake venom (ASV) is responsible for this complication as it occurs even after adequate doses of ASV administration in most cases. Acute kidney injury often requiring dialysis is invariably present in all patients because of reduced renal perfusion and ischemic acute tubular necrosis as a result of hypotension. Management mainly involves aggressive fluid resuscitation to maintain adequate tissue perfusion. There are no other proven effective treatment modalities, except a few reports of successful treatment with plasmapheresis. Methylprednisolone pulse therapy, terbutaline, aminophylline, and intravenous immunoglobulin are other treatment modalities tried.
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Affiliation(s)
- V Udayabhaskaran
- Department of Internal Medicine, Malabar Medical College, Kozhikode, Kerala, India
| | - E T Arun Thomas
- Department of Nephrology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Bhagya Shaji
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
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Druey KM, Parikh SM. Idiopathic systemic capillary leak syndrome (Clarkson disease). J Allergy Clin Immunol 2016; 140:663-670. [PMID: 28012935 DOI: 10.1016/j.jaci.2016.10.042] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 11/17/2022]
Abstract
In 1960, Dr Bayard Clarkson described a woman experiencing sporadic recurrent episodes of shock and anasarca. Plasma from an acute attack induced a shock-like syndrome when injected into rats. The enigmatic systemic capillary leak syndrome (SCLS) named for Dr Clarkson is characterized by transient and severe but reversible hemoconcentration and hypoalbuminemia caused by leakage of fluids and macromolecules into tissues. Although less than 500 cases of SCLS have been reported in the literature since 1960, the condition is probably underdiagnosed because of a lack of awareness and a high mortality without treatment. Allergists should be vigilant of this diagnosis because its presentation can resemble more common plasma leakage syndromes, including angioedema or systemic anaphylaxis. Although the precise molecular cause of SCLS remains unknown, substantial advances over the last 5 years have increased our understanding of SCLS pathogenesis.
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Affiliation(s)
- Kirk M Druey
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Md.
| | - Samir M Parikh
- Center for Vascular Biology Research and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
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A case report of idiopathic systemic capillary leak syndrome that occurred during the postoperative period of abdominoperineal resection for colorectal cancer. Int Surg 2016; 100:58-62. [PMID: 25594640 DOI: 10.9738/intsurg-d-13-00206.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 57-year-old woman without any past medical history underwent abdominoperineal resection for rectal cancer in our department. On postoperative day 15, the patient complained of sudden abdominal pain, and high fever was noted in addition to the appearance of erythema around the stoma. The diagnosis of phlegmon was made, and antibiotic infusion was started. However, a few days later, the patient developed hypovolemic shock with hypoalbuminemia and hemoconcentration. Fasciotomy was performed to exclude the necrotizing fasciitis, though all cultures were negative. Upon exclusion of the differential diagnoses, idiopathic systemic capillary leak syndrome (ISCLS) was diagnosed. She was successfully treated with massive fluid infusion under ventilation and continuous hemodiafiltration. Here, we report the first case of ISCLS that occurred during the postoperative period of colorectal surgery.
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Compartment Syndrome as a Result of Systemic Capillary Leak Syndrome. Case Rep Crit Care 2016; 2016:4206397. [PMID: 27688917 PMCID: PMC5027304 DOI: 10.1155/2016/4206397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022] Open
Abstract
Objective. To describe a single case of Systemic Capillary Leak Syndrome (SCLS) with a rare complication of compartment syndrome. Patient. Our patient is a 57-year-old male, referred to our hospital due to polycythemia (hemoglobin (Hgb) of 220 g/L), hypotension, acute renal failure, and bilateral calf pain. Measurements and Main Results. The patient required bilateral forearm, thigh, and calf fasciotomies during his ICU stay and continuous renal replacement therapy was instituted following onset of acute renal failure and oliguria. Ongoing hemodynamic (Norepinephrine and Milrinone infusion) and respiratory (ventilator) support in the ICU was provided until resolution of intravascular fluid extravasation. Conclusions. SCLS is an extremely rare disorder characterized by unexplained episodic capillary hyperpermeability, which causes shift of volume and protein from the intravascular space to the interstitial space. Patients present with significant hypotension, hemoconcentration, hypovolemia, and oliguria. Severe edema results from leakage of fluid and proteins into tissue. The most important part of treatment is maintaining stable hemodynamics, ruling out other causes of shock and diligent monitoring for complications. Awareness of the clinical syndrome with the rare complication of compartment syndrome may help guide investigations and diagnoses of these critically ill patients.
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Lilly CM, Silverman ES, Sheffer AL. Systemic Capillary Leak Syndrome, Leukotrienes, and Anaphylaxis. J Intensive Care Med 2016. [DOI: 10.1177/0885066602017004006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association of cysteinyl leukotrienes with plasma exudation allowed the authors to form the hypothesis that rates of leukotriene excretion would be increased in the acute phase of systemic capillary leak syndrome (SCLS) and that leukotriene-modifier therapy would reduce the frequency and severity of life-threatening episodes. The authors report the association of SCLS in 3 cases, 1 with seafood-induced anaphylaxis. Rates of urinary leukotriene excretion were greater during the evolution of an episode than after resolution. In a third case, the rate of urinary leukotriene excretion was significantly higher when symptoms were evolving than when they were absent (230 ± 17 vs 110 ± 6 pg/mg, P < 0.001). Treatment with a leukotriene receptor (cys-LT1) antagonist eliminated episodes in 1 patient. Treatment with the 5-lipoxygenase inhibitor zileuton was completely effective in another patient and prevented life-threatening episodes in the patient with SCLS after seafood exposure. The authors' finding that allergen exposure—associated episodes of SCLS were eliminated by allergen avoidance implies that anaphylaxis can present as SCLS. The acute phase of all 3 forms of SCLS (paraprotein associated, anaphylaxis associated, and idiopathic) is associated with increased excretion of cystinyl leukotrienes, and leukotriene-modifier treatment appears to control the disease.
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Affiliation(s)
- Craig M. Lilly
- Combined Program in Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA,
| | - Eric S. Silverman
- Combined Program in Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Albert L. Sheffer
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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A Systemic Capillary Leak Syndrome (Clarkson Syndrome) in a Patient with Chronic Lymphocytic Leukemia: A Case Report in an Out-of-Hospital Setting. Case Rep Emerg Med 2016; 2016:5347039. [PMID: 27069700 PMCID: PMC4812218 DOI: 10.1155/2016/5347039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/18/2016] [Accepted: 02/28/2016] [Indexed: 11/24/2022] Open
Abstract
Systemic Capillary Leak Syndrome (SCLS) is a rare disease with poor prognosis, characterized by the occurrence of mucocutaneous and visceral edema with hypotension, hemoconcentration, and unexpected hypoalbuminemia. The disease can be idiopathic (Clarkson syndrome) or secondary to other diseases and treatments. We describe this syndrome in a prehospitalized, 63-year-old patient with chronic lymphocytic leukemia and an idiopathic form of SCLS manifesting as hypovolemic shock. Initial care is hospitalization in intensive care. In addition to etiological treatment if fluid replacement is necessary, treatment must be closely monitored for secondary overload complications. Catecholamine rather than arrhythmogenic support may be associated.
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Spinal Anesthesia in a Patient With a History of Systemic Capillary Leak Syndrome (Clarkson Disease). Reg Anesth Pain Med 2015; 40:723-5. [PMID: 26237002 DOI: 10.1097/aap.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to review the relative risks, benefits, and anesthetic considerations of neuraxial, regional, and general anesthesia in a patient with known systemic capillary leak syndrome (SCLS) who presents for elective total knee replacement. CASE REPORT Systemic capillary leak syndrome (or Clarkson disease) is a rare disorder involving endothelial dysfunction of uncertain pathogenesis characterized by the development of hypotension, hemoconcentration, and hypoalbuminemia in the absence of secondary causes of shock. Literature regarding the anesthetic management of such patients is extremely sparse. To date, all published cases involved those who experienced exacerbations preoperatively, intraoperatively, or postoperatively. There are no reports pertaining to the anesthetic management of patients with a history of the disease who are under remission. We present a case report of a patient with a history of SCLS who underwent elective unilateral total knee arthroplasty under spinal anesthesia. The patient tolerated the procedure well without any evidence of perioperative capillary leak exacerbation. CONCLUSIONS Spinal anesthesia constitutes a viable option for a patient with a history of SCLS in sustained remission. It remains unclear whether general or neuraxial anesthesia confers the best risk-to-benefit ratio for such patients.
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Aroney N, Ure S, White H, Sane S. Recurrent undifferentiated shock: Idiopathic Systemic Capillary Leak Syndrome. Clin Case Rep 2015; 3:527-30. [PMID: 26273434 PMCID: PMC4527788 DOI: 10.1002/ccr3.280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/02/2015] [Accepted: 01/20/2015] [Indexed: 11/25/2022] Open
Abstract
Idiopathic Systemic Capillary Leak Syndrome is a potentially fatal disorder that is under diagnosed. It commonly presents as recurrent undifferentiated shock with hypotension, hypoalbuminemia and hemoconcentration. There are three distinct phases that define the syndrome; Prodromal, Extravasation and Recovery.
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Affiliation(s)
- Nicholas Aroney
- Logan Hospital Intensive Care Unit Brisbane, Queensland, Australia
| | - Stewart Ure
- Logan Hospital Intensive Care Unit Brisbane, Queensland, Australia
| | - Hayden White
- Logan Hospital Intensive Care Unit Brisbane, Queensland, Australia
| | - Sunil Sane
- Logan Hospital Intensive Care Unit Brisbane, Queensland, Australia
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Hirosaki Y, Hayashidani S, Ouchi S, Ohshima T, Nakano R, Yamamoto H. A fatal case of acute progression of generalized edema and simultaneous flash pulmonary edema in a patient with idiopathic systemic capillary leak syndrome: a case report. J Med Case Rep 2015; 9:90. [PMID: 25928289 PMCID: PMC4422423 DOI: 10.1186/s13256-015-0544-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/13/2015] [Indexed: 12/30/2022] Open
Abstract
Introduction Idiopathic systemic capillary leak syndrome is a rare and fatal disease due to the unexplained episodic attacks of capillary leakage of plasma from the intravascular into the interstitial space. The attack consists of three phases, a prodromal phase, peripheral leak phase and recruitment phase. During the peripheral leak phase, generalized edema, mainly in the trunk and extremities, with hemoconcentration and hypoalbuminemia occurs, while usually the visceral organs like lungs, brain, heart and kidneys seem not to be involved. Treatment of the acute phase is supportive, focusing on adequate but not overzealous fluid resuscitation, because pulmonary edema usually occurs in the recruitment phase. Case presentation A 65-year-old Japanese woman was admitted to our hospital because of severe hypovolemic shock with metabolic acidosis and hemoconcentration and hypoalbuminemia. Although she was considered to be in the peripheral leak phase of idiopathic systemic capillary leak syndrome, which could not be diagnosed during the treatment, the generalized edema worsened further, severe flash pulmonary edema progressed rapidly after fluid resuscitation and she died. The autopsy showed generalized edema, especially alveolar pulmonary edema without endothelial apoptosis. Conclusions Because hypovolemic shock and fatal pulmonary edema may progress rapidly together even in the peripheral leak phase of idiopathic systemic capillary leak syndrome, we should keep in mind this rare and fatal disease and recognize the pathophysiology to treat it effectively when the patient has hypovolemia with metabolic acidosis.
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Affiliation(s)
- Yuri Hirosaki
- Department of Internal Medicine, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
| | - Shunji Hayashidani
- Department of Internal Medicine, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
| | - Sayako Ouchi
- Department of Pathology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
| | - Tukasa Ohshima
- Department of Internal Medicine, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
| | - Ryuji Nakano
- Department of Pathology, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
| | - Hideo Yamamoto
- Department of Internal Medicine, Japan Community Health Care Organization (JCHO) Kyushu Hospital, 1-8-1 Kishinoura Yahata-Nishiku, Kitakyushu City, Fukuoka Prefecture, 806-8501, Japan.
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34
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[General anaesthesia in a patient with Clarkson syndrome]. ACTA ACUST UNITED AC 2015; 59:107-8. [PMID: 22480558 DOI: 10.1016/j.redar.2012.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 02/06/2012] [Indexed: 11/20/2022]
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Duron L, Delestre F, Amoura Z, Arnaud L. [Idiopathic and secondary capillary leak syndromes: A systematic review of the literature]. Rev Med Interne 2015; 36:386-94. [PMID: 25600329 DOI: 10.1016/j.revmed.2014.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The capillary leak syndrome (CLS) is a rare condition characterized by the onset of hypotension, edema, hemoconcentration and hypoalbuminemia. CLS can be idiopathic (Clarkson's disease) or secondary to various conditions and treatments. Here, we review the clinical and biological features, pathophysiology, causes and treatment of this rare condition. METHODS We performed a systematic review of the literature (Medline database through February 2014) to identify all articles about CLS. The relevant references were selected by two independent authors. RESULTS Secondary CLSs are mostly due to malignant hematological diseases, viral infections, and treatments such as chemotherapies and therapeutic growth factors. Diagnosis of idiopathic CLS is made by exclusion of secondary diseases, especially as a serum monoclonal immunoglobulin is present, or when there is a relapsing disease, no initial lung involvement or preserved consciousness despite low blood pressure. Acute episodes are treated with vasopressor therapy and judicious fluid replacement. Between episodes, patients with Clarkson's disease may be treated with intravenous immunoglobulins. CLS is a severe disease with significantly impaired prognosis. CONCLUSION Clarification of the pathophysiological mechanisms of CLS is essential to improve the prognosis of this rare disease with more targeted treatments.
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Affiliation(s)
- L Duron
- Service de médecine interne 2, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Delestre
- Service de médecine interne 2, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Z Amoura
- Service de médecine interne 2, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; UPMC université Paris 06, Sorbonne universités, 75013 Paris, France
| | - L Arnaud
- Service de médecine interne 2, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; UPMC université Paris 06, Sorbonne universités, 75013 Paris, France.
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36
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Bouchet JL, Vital C, Ferrer X, Vital A. Systemic capillary leak syndrome in an 85-year-old man (Clarkson's syndrome). Rev Neurol (Paris) 2014; 170:713-4. [PMID: 25287734 DOI: 10.1016/j.neurol.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/19/2014] [Accepted: 05/28/2014] [Indexed: 10/24/2022]
Affiliation(s)
- J-L Bouchet
- Service de pathologie, hôpital Pellegrin, université de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - C Vital
- Service de pathologie, hôpital Pellegrin, université de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - X Ferrer
- Service de pathologie, hôpital Pellegrin, université de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - A Vital
- Service de pathologie, hôpital Pellegrin, université de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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Pothen L, Rouvière H, Poncin R, Michaux L, Damoiseau P, Lambert M. Systemic capillary leak syndrome revealing a diffuse large B-cell lymphoma. Acta Clin Belg 2014; 69:305-8. [PMID: 24942976 DOI: 10.1179/0001551214z.00000000076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We report on a 75-year-old woman who presented with recurrent episodes of hypotension, anasarca, renal failure, hypoalbuminaemia without proteinuria, suggestive of systemic capillary leak syndrome (SCLS). Further investigations led to a diagnosis of diffuse large B-cell lymphoma. Secondary SCLS associated with non-Hodgkin lymphoma is reviewed.
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38
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Jeong EK, Kim YK, Kim SH, Lee CH, Kim JS. Systemic capillary leak syndrome under general anesthesia: a case report. Korean J Anesthesiol 2014; 66:462-6. [PMID: 25006371 PMCID: PMC4085268 DOI: 10.4097/kjae.2014.66.6.462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/27/2013] [Accepted: 05/28/2013] [Indexed: 11/27/2022] Open
Abstract
Systemic capillary leak syndrome (SCLS) is very rare and lethal disease and only 150 cases have been reported after the first publication of its report in 1960 by Clarkson. SCLS is characterized by hemoconcentation and hypoalbuminemia caused by reversible plasma extravasation. Its mechanism is unknown, but transient dysfunction of the endothelium is the most suspected cause and trigger of this event may cause immunologic disarrangement. After recovery of endothelial function, fluid injected during the shock period is redistributed and can cause severe pulmonary edema. SCLS should be considered in patients with acute and severe hypotension with hemoconcentration and hypoalbuminemia without obvious cardiac dysfunction. Especially we should take into account the possibility of SCLS if fluid replacement does not work or the shock state is aggravated despite aggressive fluid resuscitation and vasopressor administration. SCLS itself is a very rare disease; furthermore, SCLS that develops during well-controlled surgery is even more rare. So we report this case with review of the literature.
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Affiliation(s)
- Eui-Kyun Jeong
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Young-Ki Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Se-Hun Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Chang-Hee Lee
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Jin-Sun Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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39
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Uso de inmunoglobulinas inespecíficas en un paciente con síndrome de fuga capilar. Med Clin (Barc) 2014; 142:377-8. [DOI: 10.1016/j.medcli.2013.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/13/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022]
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40
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Miyata K, Mikami T, Mikuni N, Aisaka W, Irifune H, Narimatsu E. Malignant hemispheric cerebral infarction associated with idiopathic systemic capillary leak syndrome. Case Rep Neurol 2013; 5:175-82. [PMID: 24163674 PMCID: PMC3806694 DOI: 10.1159/000355637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Idiopathic systemic capillary leak syndrome (ISCLS) is a rare condition that is characterized by unexplained episodic capillary hyperpermeability due to a shift of fluid and protein from the intravascular to the interstitial space. This results in diffuse general swelling, fetal hypovolemic shock, hypoalbuminemia, and hemoconcentration. Although ISCLS rarely induces cerebral infarction, we experienced a patient who deteriorated and was comatose as a result of massive cerebral infarction associated with ISCLS. In this case, severe hypotensive shock, general edema, hemiparesis, and aphasia appeared after serious antecedent gastrointestinal symptoms. Progressive life-threatening ischemic cerebral edema required decompressive hemicraniectomy. The patient experienced another episode of severe hypotension and limb edema that resulted in multiple extremity compartment syndrome. Treatment entailed forearm and calf fasciotomies. Cerebral edema in the ischemic brain progresses rapidly in patients suffering from ISCLS. Strict control of fluid volume resuscitation and aggressive diuretic therapy may be needed during the post-leak phase of fluid remobilization.
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Affiliation(s)
- Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan ; Department of Emergency Medicine, Sapporo Medical University, Sapporo, Japan
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41
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[Skin manifestations of monoclonal gammopathies]. Rev Med Interne 2013; 35:28-38. [PMID: 24070793 DOI: 10.1016/j.revmed.2013.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 01/01/2023]
Abstract
Whatever their aetiology, monoclonal gammopathies can be associated to several clinical features. Mechanisms are various and sometimes unknown. Skin is frequently involved and may represent a challenging diagnosis. Indeed, skin manifestations are either the presenting features and isolated, or at the background of a systemic syndrome. Our objective was to review the various skin manifestations that have been associated with monoclonal gammopathies.
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42
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Muñoz-Guillén NM, León-López R, de la Cal-Ramírez MA, Dueñas-Jurado JM. [Systemic capillary leak syndrome: hypoalbuminemia, hemoconcentration and shock. Presentation of a case]. Semergen 2013; 40:e33-6. [PMID: 23768569 DOI: 10.1016/j.semerg.2013.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 01/01/2013] [Accepted: 01/10/2013] [Indexed: 10/26/2022]
Abstract
Systemic capillary leak syndrome is a rare disorder of unknown etiology and often recurrent episodes characterized by increased capillary permeability that allows a leakage of fluid and proteins from the circulatory system to the interstitial space leading to shock and massive edema. The lack of recognition of this disease may be due to its unespecific signs and symptons of presentation, its rapid clinical progression and high mortality of the acute episodes. General physicians are usually the first to evaluate patients with this kind of disorder, either in the pre-hospital situation, hospital emergency units or even (in the milder cases) in the health centers. Its poor outcome and the improvement in the prognosis, if appropriate treatment is initiated, leads us to emphasize the importance of recognizing this pathology in order to start the appropriate intensive care and emergency treatment.
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Affiliation(s)
| | - R León-López
- Unidad de Cuidados Intensivos, Hospital Universitario Reina Sofía, Córdoba, España
| | | | - J M Dueñas-Jurado
- Unidad de Cuidados Intensivos, Hospital Universitario Reina Sofía, Córdoba, España
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43
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Levinson SS. POEMS syndrome: Importance of the clinical laboratory practitioner's role. Clin Chim Acta 2012; 413:1800-7. [DOI: 10.1016/j.cca.2012.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 06/25/2012] [Accepted: 06/27/2012] [Indexed: 11/28/2022]
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44
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Síndrome de capillary leak sistémico: descripción de un caso. Med Intensiva 2012; 36:238-9. [DOI: 10.1016/j.medin.2011.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 05/15/2011] [Accepted: 05/19/2011] [Indexed: 11/22/2022]
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45
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Successful treatment of systemic capillary leak syndrome with intravenous immunoglobulins. Rev Clin Esp 2012; 212:218-9. [DOI: 10.1016/j.rce.2011.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/01/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022]
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46
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Vascular endothelial hyperpermeability induces the clinical symptoms of Clarkson disease (the systemic capillary leak syndrome). Blood 2012; 119:4321-32. [PMID: 22411873 DOI: 10.1182/blood-2011-08-375816] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The systemic capillary leak syndrome (SCLS) is a rare disorder characterized by transient episodes of hypotensive shock and anasarca thought to arise from reversible microvascular barrier dysfunction. Although the high prevalence of a monoclonal gammopathy of unknown significance in SCLS suggests a pathogenic contribution of endogenous immunoglobulins, the mechanisms of vascular hyperpermeability remain obscure. Herein, we report clinical and molecular findings on 23 patients, the largest SCLS case series to date. Application of episodic SCLS sera, but neither the purified immunoglobulin fraction nor sera obtained from patients during remission, to human microvascular endothelial cells caused vascular endothelial cadherin internalization, disruption of interendothelial junctions, actin stress fiber formation, and increased permeability in complementary functional assays without inducing endothelial apoptosis. Intravenous immunoglobulin, one promising therapy for SCLS, mitigated the permeability effects of episodic sera. Consistent with the presence of endogenous, nonimmunoglobulin, circulating permeability factor(s) constrained to SCLS episodes, we found that vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang2), were elevated in episodic SCLS sera but not in remission sera. Ab-based inhibition of Ang2 counteracted permeability induced by episodic SCLS sera. Comparable experiments with anti-VEGF Ab (bevacizumab) yielded less interpretable results, probably because of endothelial toxicity of VEGF withdrawal. Our results support a model of SCLS pathogenesis in which nonimmunoglobulin humoral factors such as VEGF and Ang2 contribute to transient endothelial contraction, suggesting a molecular mechanism for this highly lethal disorder.
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47
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Bressan AL, Gripp A, Oliveira EFD, Silva RSD. Systemic capillary leak syndrome. An Bras Dermatol 2012; 86:593-5. [PMID: 21738986 DOI: 10.1590/s0365-05962011000300031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 05/06/2010] [Indexed: 11/22/2022] Open
Abstract
The systemic capillary leak syndrome is rare and caused by increased capillary permeability. Several etiologies are involved. In our Department of Dermatology the main one is unstable psoriasis. Several treatments are used and many are still under study. Our objective was to present this potentially fatal medical condition that occurs in our specialty.
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Affiliation(s)
- Aline Lopes Bressan
- Dermatology service from the Pedro Ernesto University Hospital - Rio de Janeiro (RJ), Brazil.
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48
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Baek SH, Shin N, Kim HJ, Han MY, Choi DJ, Bang SM, Kim S, Paik JH. A Case of Chronic Renal Failure Associated with Systemic Capillary Leak Syndrome. Yeungnam Univ J Med 2012. [DOI: 10.12701/yujm.2012.29.2.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Seon Ha Baek
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nara Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi Yeun Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Ho Paik
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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49
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Ansari A, Birendra KC, Marvin M, Kubat A, Fritz T. An unusual case of swelling--Clarkson's syndrome. BMJ Case Rep 2011; 2011:bcr.06.2011.4405. [PMID: 22679048 DOI: 10.1136/bcr.06.2011.4405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clarkson's syndrome, also called idiopathic systemic capillary leak syndrome is a rare condition characterised by vascular hyper permeability resulting in extreme intravascular volume depletion. The syndrome is unique and almost paradoxical in its presentation, with findings initially suggesting overwhelming heart failure, but in reality the extra vascular fluid represents overt capillary leak, with ultimate intravascular volume depletion, a low output state and hypovolemic shock. Previously described characteristics have classically included severe oedema and anasarca with rapid, profound shock, typically accompanied by haemoconcentration. The authors describe a patient, initially seeming benign in presentation, who rapidly progressed with confusing findings of fluid overload by examination and imaging, ultimately manifesting these findings by severe capillary leak rather than hydrostatic oedema, with ultimate hypovolaemic shock, multisystem organ failure and death. Our aim is that by describing clinical, haemodynamic and pathologic descriptors of the disease, the authors can aid in increasing physician awareness of this unusual syndrome.
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Affiliation(s)
- Asif Ansari
- Department of Internal Medicine, Spectrum Health, Grand Rapids, Michigan, United States.
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Zipponi M, Eugster R, Birrenbach T. High-dose intravenous immunoglobulins: a promising therapeutic approach for idiopathic systemic capillary leak syndrome. BMJ Case Rep 2011; 2011:bcr.12.2010.3599. [PMID: 22696704 DOI: 10.1136/bcr.12.2010.3599] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The systemic capillary leak syndrome (SCLS), also known as Clarkson's disease, is a life-threatening disorder of unknown cause. It is characterised by recurrent acute episodes of hypotension, weight gain and generalised oedema with haemoconcentration and hypoproteinaemia caused by paroxysmal capillary hyperpermeability with a shift of plasma fluid from the intravascular to the interstitial space. We report the case of a 40-year-old woman with chronic SCLS treated with high-dose intravenous immunoglobulins, after a prophylactic therapy with theophylline and terbutaline was poorly tolerated and failed to decrease the frequency and severity of the attacks sufficiently.
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Affiliation(s)
- Manuel Zipponi
- Department of General Internal Medicine, Inselspital Bern, University Hospital Bern, Bern, Switzerland
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