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Molteni M, Pelitti V, Galli M, Di Natale D, Podda G, Squizzato A. Uncommon presentation of systemic capillary leak syndrome: a case report with pulmonary embolism. Intern Emerg Med 2023:10.1007/s11739-023-03479-2. [PMID: 38041767 DOI: 10.1007/s11739-023-03479-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/02/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Matteo Molteni
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese, CO, Italy
| | - Valentina Pelitti
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese, CO, Italy
| | - Matteo Galli
- Internal Medicine Unit, 'Sant'Anna' Hospital, ASST Lariana, Como, Italy
| | - Davide Di Natale
- Thoracic Surgery Unit, 'Circolo e Fondazione Macchi' Hospital, ASST Sette Laghi, Varese, Italy
| | - Gianmarco Podda
- Internal Medicine Unit, 'San Paolo' Hospital, University of Milan, Milan, Italy
| | - Alessandro Squizzato
- Internal Medicine Unit, 'Sant'Anna' Hospital, ASST Lariana, Como, Italy.
- Research Center on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, CO, Italy.
- U.O.C. Medicina Generale, Ospedale Sant'Anna-ASST Lariana, Via Ravona, 20, 22042, San Fermo Della Battaglia, CO, Italy.
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Anipindi M, Kacarow J, Bitetto D. Systemic Capillary Leak Syndrome (SCLS) Presentation in Patients Receiving Anti-cancer Treatments. Cureus 2023; 15:e38335. [PMID: 37261188 PMCID: PMC10228707 DOI: 10.7759/cureus.38335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/02/2023] Open
Abstract
Systemic capillary leak syndrome (SCLS) is due to increased capillary permeability to proteins and fluid extravasation from blood vessels into surrounding tissues and body cavities. This fluid extravasation leads to hypotension, generalized anasarca, pleural effusions, and pericardial effusions -- the more severe cases of SCLS can cause multiorgan dysfunction, including cardiovascular collapse, shock, and death. The treatment includes corticosteroids, diuretics, albumin, immunoglobulins, and crystalloids. SCLS is potentially fatal. Recognizing signs and symptoms early and treating the patients is essential as this condition is fatal. It sometimes is a diagnosis of exclusion, being very challenging to diagnose and treat. The lack of understanding of the underlying mechanisms causing SCLS and proper treatment guidelines, especially in cancer patients, made diagnosing and treating this condition hard. Reports show that many cancers and anti-cancer treatments, including newer immunotherapy, cause SCLS. The mortality rate of SCLS associated with cytotoxic chemotherapy is 24% at five years. This review focuses on the cancers and anti-cancer drugs causing SCLS, treating acute SCLS, and available preventive regimens. The fundamental purpose of this review is to help clinicians recognize SCLS early to avoid delays in diagnosis and treatment. We also would like to elaborate on the fact that research on cancer-related SCLS is critical for developing staging criteria, useful diagnostic markers, prevention, and treatment strategies for anti-cancer drug-induced SCLS to prevent early discontinuation of anti-cancer drugs.
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Affiliation(s)
- Manasa Anipindi
- Internal Medicine, Einstein Medical Center Montgomery, East Norriton, USA
| | - Justyna Kacarow
- Internal Medicine, Einstein Medical Center Montgomery, East Norriton, USA
| | - Daniel Bitetto
- Hospital Medicine, Einstein Medical Center Montgomery, East Norriton, 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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Bichon A, Bourenne J, Gainnier M, Carvelli J. Capillary leak syndrome: State of the art in 2021. Rev Med Interne 2021; 42:789-796. [PMID: 34099313 DOI: 10.1016/j.revmed.2021.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Capillary leak syndrome (CLS) is an increasingly acknowledged multifaceted and potentially lethal disease. Initial nonspecific symptoms are followed by the intriguing CLS hallmark: the double paradox associating diffuse severe edema and hypovolemia, along with hemoconcentration and hypoalbuminemia. Spontaneous resolutive phase is often associated with poor outcome due to iatrogenic fluid overload during leak phase. CLS is mainly triggered by drugs (anti-tumoral therapies), malignancy, infections (mostly viruses) and inflammatory diseases. Its idiopathic form is named after its eponymous finder: Clarkson's disease. CLS pathophysiology involves a severe, transient and multifactorial endothelial disruption which mechanisms are still unclear. Empirical and based-on-experience treatment implies symptomatic care during the acute phase (with the eventual addition of drugs amplifying cAMP levels in the severest cases), and the prophylactic use of monthly polyvalent immunoglobulins to prevent relapses. As CLS literature is scattered, we aimed to collect and summarize the current knowledge on CLS to facilitate its diagnosis, understanding and management.
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Affiliation(s)
- A Bichon
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France.
| | - J Bourenne
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
| | - M Gainnier
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
| | - J Carvelli
- Service de réanimation des urgences, hôpital de la Timone, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France
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Shimada S, Kawasaki H, Diao Y, Ren HY, Li WH, Tang MQ. Epstein-Barr virus is a promoter of lymphoma cell metastasis. Pathology 2020; 52:676-685. [PMID: 32768248 DOI: 10.1016/j.pathol.2020.05.005] [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] [Received: 01/22/2020] [Revised: 05/03/2020] [Accepted: 05/13/2020] [Indexed: 02/04/2023]
Abstract
It is well-known that Epstein-Barr virus (EBV) is the promoter of cell tumourigenesis. We found that EBV is also a promoter of lymphoma cell dissemination, because we found the typical morphopathological phenomenon of cell adhesion, which confirmed that the adhesion of tumour cells was higher than that of normal cells. We also observed that tumour cells disrupted the dynamic pathological changes of vascular endothelial cells, and this made it clear that the rate of tumour cell metastasis was directly proportional to the degree of EBV infection. Furthermore, when we discovered exosomes, it was considered that this was associated with cancer stem cells, suggesting the formation of a microenvironment before tumour cell metastasis. In addition, competitive inhibition was found in cell adhesion, indicating the breakthrough point of preventing tumour cell metastasis, which has clinical reference value for tumour immunotherapy.
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Affiliation(s)
- Shinji Shimada
- School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, China.
| | | | - Yong Diao
- School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, China
| | - Hong-Yun Ren
- Institute of Urban Environment, Chinese Academy of Science, Xiamen, China
| | - Wen-Hua Li
- School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, China
| | - Ming-Qing Tang
- School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, China
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