101
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Systemic capillary leak syndrome: is methylene blue the silver bullet? Case Rep Crit Care 2014; 2014:141670. [PMID: 25544902 PMCID: PMC4273586 DOI: 10.1155/2014/141670] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by unexplained, recurrent episodes of transient, abrupt increase in endothelial permeability, leading to severe hypotension, generalized edema, and hemoconcentration. Case Report. We report the case of a patient suffering from systemic capillary leak syndrome and present a possible interpretation of the pathophysiology of this condition. Besides the classical triad of hypotension, edema, and hemoconcentration, we recorded increased levels of methemoglobin, an index of NO overproduction. We present a possible interpretation of the pathophysiology of this condition based on the fast and complete reversal of symptoms after methylene blue administration (which opposes NO-induced effects) and speculate that increased NO levels could be implicated in the pathophysiology of the capillary leak phase. Why should an emergency physician be aware of this? The safety of this treatment and its fluid- and cathecolamine-sparing effect deserve consideration and further research.
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102
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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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103
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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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104
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Saito TB, Thirumalapura NR, Shelite TR, Rockx-Brouwer D, Popov VL, Walker DH. An animal model of a newly emerging human ehrlichiosis. J Infect Dis 2014; 211:452-61. [PMID: 24990203 DOI: 10.1093/infdis/jiu372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human ehrlichioses are emerging life-threatening diseases transmitted by ticks. Animal models have been developed to study disease development; however, there is no valid small animal model that uses a human ehrlichial pathogen. The objective of this study was to develop a mouse model for ehrlichiosis with the newly discovered human pathogen, Ehrlichia muris-like agent (EMLA). METHODS Three strains of mice were inoculated with different doses of EMLA by the intravenous, intraperitoneal, or intradermal route and evaluated for clinical and pathologic changes during the course of infection. RESULTS EMLA infected C57Bl/6, BALB/c, and C3H/HeN mice and induced lethal or persistent infection in a route- and dose-dependent manner. The clinical chemistry and hematologic changes were similar to those of human infection by Ehrlichia chaffeensis or EMLA. Bacterial distribution in tissues differed after intradermal infection, compared with the distribution after intravenous or intraperitoneal injection. Lethal infection did not cause remarkable pathologic changes, but it caused fluid imbalance. EMLA infection of endothelium and mononuclear cells likely plays a role in the severe outcome. CONCLUSIONS The EMLA mouse model mimics human infection and can be used to study pathogenesis and immunity and for development of a vector transmission model of ehrlichiosis.
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Affiliation(s)
- Tais Berelli Saito
- Department of Pathology, University of Texas Medical Branch at Galveston
| | | | - Thomas R Shelite
- Department of Pathology, University of Texas Medical Branch at Galveston
| | | | - Vsevolod L Popov
- Department of Pathology, University of Texas Medical Branch at Galveston
| | - David H Walker
- Department of Pathology, University of Texas Medical Branch at Galveston
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105
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Xie Z, Ghosh CC, Parikh SM, Druey KM. Mechanistic classification of the systemic capillary leak syndrome: Clarkson disease. Am J Respir Crit Care Med 2014; 189:1145-7. [PMID: 24787070 DOI: 10.1164/rccm.201310-1746le] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Zhihui Xie
- 1 National Institute of Allergy and Infectious Diseases/National Institutes of Health Bethesda, Maryland
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106
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Rabbolini DJ, Ange N, Walters GD, Pidcock M, Randall KL. Systemic capillary leak syndrome: recognition prevents morbidity and mortality. Intern Med J 2014; 43:1145-7. [PMID: 24134172 DOI: 10.1111/imj.12271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 02/02/2013] [Indexed: 11/30/2022]
Abstract
Idiopathic systemic capillary leak syndrome (SCLS) is extremely rare but carries a high morbidity and mortality. The diagnosis is made clinically by a classic triad of hypotension, hypoalbuminaemia and haemoconcentration. There have been recent advances in understanding the pathophysiological basis for SCLS and in effective prophylaxis. We report a case of SCLS to increase awareness of the condition and to highlight the benefits of prophylactic intravenous immunoglobulin in this condition.
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Affiliation(s)
- D J Rabbolini
- Department of Haematology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
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107
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Hayama M, Shime N, Mio T. Invasive pulmonary aspergillosis in a patient presenting with idiopathic systemic capillary leak syndrome. BMJ Case Rep 2014; 2014:bcr-2014-203764. [PMID: 24859554 DOI: 10.1136/bcr-2014-203764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
A 54-year-old man presented to our emergency department with fever and dyspnoea. He required vigorous haemodynamic support and mechanical ventilation for hypotensive distributive shock with hypoalbuminaemia, haemoconcentration, rhabdomyolysis and acute renal failure, consistent with idiopathic systemic capillary leak syndrome. Left lung consolidation and hypoxaemia were observed 6 days after admission. Sputum smear revealed the presence of acute angled branching hyphae, consistent with a diagnosis of invasive pulmonary aspergillosis. Antifungal therapy was administered and mechanical ventilation discontinued on day 66. The patient recovered and was discharged from the hospital on day 185.
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Affiliation(s)
- Manabu Hayama
- Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto-shi, Kyoto, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, National Hospital Organization Kyoto Medical Center, Kyoto-shi, Kyoto, Japan
| | - Tadashi Mio
- Department of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto-shi, Kyoto, Japan
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108
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Xie Z, Chan E, Yin Y, Ghosh CC, Wisch L, Nelson C, Young M, Parikh SM, Druey KM. Inflammatory Markers of the Systemic Capillary Leak Syndrome (Clarkson Disease). JOURNAL OF CLINICAL & CELLULAR IMMUNOLOGY 2014; 5:1000213. [PMID: 25405070 PMCID: PMC4232957 DOI: 10.4172/2155-9899.1000213] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The Systemic Capillary Leak Syndrome (SCLS) is a rare and potentially fatal disorder resembling systemic anaphylaxis that is characterized by transient episodes of hypotensive shock and peripheral edema. The pathogenesis of SCLS is unknown, and triggers for attacks are apparent only in a minority of patients. We introduce a clinical algorithm for the diagnosis of SCLS, and we investigated potential serum biomarkers of acute SCLS episodes. METHODS We analyzed serum cytokines in a cohort of 35 patients with an established diagnosis of SCLS and characterized the effects of SCLS sera on endothelial cell function. We investigated the cellular source(s) of CXCL10, a chemokine that was significantly elevated in both basal and acute SCLS sera, by flow cytometry. RESULTS Several cytokines were elevated in acute SCLS sera compared to baseline or sera from healthy controls, including CXCL10, CCL2, IL-1β, IL-6, IL-8, IL-12 and TNFα. The majority of acute sera failed to activate endothelial cells as assessed by surface adhesion marker expression. Monocytes appear to be the major source of serum CXCL10, and the percentage of CXLC10+ monocytes in response to IFNγ stimulation was increased in SCLS subjects compared to controls. CONCLUSIONS The presence of proinflammatory cytokines in acute SCLS sera suggests that inflammation or infection may have a role in triggering episodes. The enhanced capacity of monocytes from SCLS patients to produce CXCL10 suggests a new therapeutic avenue for SCLS.
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Affiliation(s)
- Zhihui Xie
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
| | - Eunice Chan
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
| | - Yuzhi Yin
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
| | - Chandra C. Ghosh
- Department of Medicine, Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Laura Wisch
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
| | - Celeste Nelson
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
| | - Michael Young
- Clinical Research Directorate/CMRP, Leidos Biomedical Research Inc., Frederick, National Laboratory for Cancer Research, Frederick, MD, USA
| | - Samir M. Parikh
- Department of Medicine, Division of Nephrology and Center for Vascular Biology Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kirk M. Druey
- Laboratory of Allergic Diseases, NIAID/NIH, Bethesda, MD, USA
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109
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Xie Z, Nagarajan V, Sturdevant DE, Iwaki S, Chan E, Wisch L, Young M, Nelson CM, Porcella SF, Druey KM. Genome-wide SNP analysis of the Systemic Capillary Leak Syndrome (Clarkson disease). Rare Dis 2013; 1:e27445. [PMID: 24808988 PMCID: PMC4009617 DOI: 10.4161/rdis.27445] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/21/2013] [Accepted: 12/05/2013] [Indexed: 12/14/2022] Open
Abstract
The Systemic Capillary Leak Syndrome (SCLS) is an extremely rare, orphan disease that resembles, and is frequently erroneously diagnosed as, systemic anaphylaxis. The disorder is characterized by repeated, transient, and seemingly unprovoked episodes of hypotensive shock and peripheral edema due to transient endothelial hyperpermeability. SCLS is often accompanied by a monoclonal gammopathy of unknown significance (MGUS). Using Affymetrix Single Nucleotide Polymorphism (SNP) microarrays, we performed the first genome-wide SNP analysis of SCLS in a cohort of 12 disease subjects and 18 controls. Exome capture sequencing was performed on genomic DNA from nine of these patients as validation for the SNP-chip discoveries and de novo data generation. We identified candidate susceptibility loci for SCLS, which included a region flanking CAV3 (3p25.3) as well as SNP clusters in PON1 (7q21.3), PSORS1C1 (6p21.3), and CHCHD3 (7q33). Among the most highly ranked discoveries were gene-associated SNPs in the uncharacterized LOC100130480 gene (rs6417039, rs2004296). Top case-associated SNPs were observed in BTRC (rs12355803, 3rs4436485), ARHGEF18 (rs11668246), CDH13 (rs4782779), and EDG2 (rs12552348), which encode proteins with known or suspected roles in B cell function and/or vascular integrity. 61 SNPs that were significantly associated with SCLS by microarray analysis were also detected and validated by exome deep sequencing. Functional annotation of highly ranked SNPs revealed enrichment of cell projections, cell junctions and adhesion, and molecules containing pleckstrin homology, Ras/Rho regulatory, and immunoglobulin Ig-like C2/fibronectin type III domains, all of which involve mechanistic functions that correlate with the SCLS phenotype. These results highlight SNPs with potential relevance to SCLS.
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Affiliation(s)
- Zhihui Xie
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
| | - Vijayaraj Nagarajan
- Computational Biology Section; Bioinformatics and Computational Biosciences Branch; OCICB; NIAID/NIH; Bethesda, MD USA
| | - Daniel E Sturdevant
- Genomics Unit, Research Technologies Section; Rocky Mountain Laboratories; NIAID/NIH, Hamilton, MT USA
| | - Shoko Iwaki
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
| | - Eunice Chan
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
| | - Laura Wisch
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
| | - Michael Young
- Clinical Research Directorate/CMRP; SAIC-Frederick, Inc; Frederick National Laboratory for Clinical Research; Frederick, MD USA
| | - Celeste M Nelson
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
| | - Stephen F Porcella
- Genomics Unit, Research Technologies Section; Rocky Mountain Laboratories; NIAID/NIH, Hamilton, MT USA
| | - Kirk M Druey
- Molecular Signal Transduction Section; NIAID/NIH; Bethesda, MD USA
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110
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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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111
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Juthier F, Ennezat PV, Fornes P, Hachulla E, Hatron PY, Robin E, Prat A, Bouchindhomme B, Banfi C, Fouquet O, Vincentelli A. Myocardial involvement in systemic capillary leak syndrome: first demonstration by pathologic findings. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:248-52. [PMID: 24062914 DOI: 10.1177/2048872612455142] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/25/2012] [Indexed: 11/16/2022]
Abstract
This case vignette relates the unknown association between systemic capillary leak syndrome, namely Clarkson's syndrome, and acute cardiac dysfunction. 'Central extra-corporeal life support (ECLS)' was needed for the management of an intractable cardiogenic shock. The acute cardiac condition completely resolved within few days. Pathology showed diffuse interstitial edema within the myocardium suggestive of cardiac involvement of the disease.
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Affiliation(s)
- Francis Juthier
- Centre Hospitalier et Régional Universitaire de Lille, Department of Cardiovascular Surgery, Lille, France ; Université Lille Nord de France, Lille, France
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112
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Milani GP, Dellepiane RM, Castellazzi ML, Mazzoni MBM, Bianchetti MG, Fossali EF. Episodic idiopathic systemic capillary leak syndrome in a girl. Pediatr Int 2013; 55:e81-2. [PMID: 23910812 DOI: 10.1111/ped.12068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 12/21/2012] [Accepted: 02/01/2013] [Indexed: 11/29/2022]
Abstract
Episodic idiopathic systemic capillary leak syndrome is a rare disorder that presents with attacks of circulatory shock due to plasma leakage into the extravascular space. Reported here is the case of a girl who had recurrent circulatory shock. The diagnosis of episodic idiopathic systemic capillary leak syndrome was made following the fourth episode. The course was favorable following acute i.v. cristalloids and methylprednisolone.
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Affiliation(s)
- Gregorio Paolo Milani
- Pediatric Emergency Unit, Clinica De Marchi, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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113
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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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114
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Kyriakides T, Angelini C, Schaefer J, Mongini T, Siciliano G, Sacconi S, Joseph J, Burgunder JM, Bindoff LA, Vissing J, de Visser M, Hilton-Jones D. EFNS review on the role of muscle biopsy in the investigation of myalgia. Eur J Neurol 2013; 20:997-1005. [DOI: 10.1111/ene.12174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- T. Kyriakides
- Clinical Neurosciences; Cyprus Institute of Neurology and Genetics; Nicosia Cyprus
| | - C. Angelini
- IRCCS Fondazione Ospedale San Camillo; Venezia Italy
| | - J. Schaefer
- Department of Neurology; University of Dresden; Dresden Germany
| | - T. Mongini
- Neuromuscular Center; S.G. Battista Hospital; University of Turin; Turin Italy
| | - G. Siciliano
- Department of Neuroscience; Neurological Clinic; University of Pisa; Pisa Italy
| | - S. Sacconi
- Centre de reference des Maladies nueuromusculaires; CNRS UMR6543; Nice University Hospital; Nice France
| | - J. Joseph
- St George's University of London at the University of Nicosia Medical School; Nicosia Cyprus
| | - J. M. Burgunder
- Departments of Neurology and Clinical Research; University of Bern; Inselspital; Bern Switzerland
| | - L. A. Bindoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. Vissing
- Neuromuscular Clinic and Research Unit; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. de Visser
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - D. Hilton-Jones
- Oxford Neuromuscular Centre; Department of Neurology; John Radcliffe Hospital; Oxford UK
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115
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Besteiro Grandío B, Vázquez González A, Madruga Garrido M, Mourelo Fariña M. [Issues about systemic capillary leak syndrome]. Med Intensiva 2012; 36:597-8. [PMID: 22749534 DOI: 10.1016/j.medin.2012.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
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116
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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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117
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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: 143] [Impact Index Per Article: 11.9] [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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118
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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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119
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Bencsath KP, Reu F, Dietz J, Hsi ED, Heresi GA. Idiopathic systemic capillary leak syndrome preceding diagnosis of infiltrating lobular carcinoma of the breast with quiescence during neoadjuvant chemotherapy. Mayo Clin Proc 2011; 86:260-1. [PMID: 21364118 PMCID: PMC3046949 DOI: 10.4065/mcp.2010.0819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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