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Liu J, Gao YQ, Fu W. Ultrasound findings and specific intrinsic blood volume expansion therapy for neonatal capillary leak syndrome: report from a multicenter prospective self-control study. Eur J Med Res 2024; 29:150. [PMID: 38429824 PMCID: PMC10908005 DOI: 10.1186/s40001-024-01738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE Capillary leak syndrome (CLS) is characterized by severe systemic edema without specific treatment, resulting in a high mortality rate. This study investigated whether there is organ edema in neonatal CLS patients and specific treatment strategies to improve patient prognosis. METHODS Thirty-seven newborns diagnosed with CLS were included in this study. (1) Routine point-of-care ultrasound (POCUS) was used to identify whether the patients had visceral edema or fluid collection. (2) All patients were treated with 3% NaCl intravenously, and the clinical manifestations, laboratory indices and outcomes were compared before and after treatment. RESULTS (1) Diffuse severe edema was found in 92.0% of the patients. (2) The POCUS examination revealed that CLS patients exhibited significant visceral edema in addition to diffuse severe edema, which included pulmonary edema in 67.6%, cerebral edema in 37.8%, severe intestinal edema in 24.3%, severe myocardial edema in 8.1%, pericardial effusion in 5.4%, pleural effusion in 29.7% and peritoneal effusion in 18.9%. Two patients (5.45%) had only myocardial edema without other manifestations. (3) Before and after the intravenous injection of 3% NaCl, there were no significant differences in the serum sodium or potassium levels of CLS patients, while the hemoglobin and hematocrit levels were significantly lower after treatment (p < 0.01). Her plasma ALB concentration and arterial pressure returned to normal levels after the treatment was completed. (4) All the patients survived, and no side effects or complications were observed during or after treatment with 3% NaCl. CONCLUSIONS (1) In addition to diffuse severe edema, visceral edema and effusion are common and important clinical manifestations of neonatal CLS and need to be detected by routine POCUS. (2) The intravenous injection of 3% NaCl is a safe, effective and specific treatment strategy for neonatal CLS, with a survival rate of 100% and no adverse effects.
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Affiliation(s)
- Jing Liu
- Department of Neonatology and NICU, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
- Beijing Maternal and Child Health Care Hospital, Beijing, 100026, China.
- Department of Neonatology and NICU, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China.
| | - Yue-Qiao Gao
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China
| | - Wei Fu
- Department of Neonatology and NICU, Beijing Chao-Yang District Maternal and Child Health Care Hospital, Beijing, 100026, China
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Okamura T, Murata S, Miyamoto K, Tane M, Okabe Y, Takeda S, Tabata S, Kosako H, Hori Y, Yamashita Y, Mushino T, Hosoi H, Sonoki T. [Veno-venous extracorporeal membrane oxygenation for capillary leak syndrome during induction chemotherapy in acute myeloid leukemia]. Rinsho Ketsueki 2024; 65:169-174. [PMID: 38569861 DOI: 10.11406/rinketsu.65.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
A 44-year-old woman was diagnosed with acute myeloid leukemia (RUNX1::RUNX1T1 translocation) and received induction chemotherapy with idarubicin hydrochloride and cytosine arabinoside. The pneumonia that had been present since admission worsened, and a drug-induced skin rash appeared. On day 17, she presented with respiratory failure and shock, complicated by hemoconcentration and hypoalbuminemia. This was considered capillary leak syndrome due to pneumonia and drug allergy, so she was started on pulse steroid therapy and IVIG, and was intubated on the same day. On day 18, venovenous-extracorporeal membrane oxygenation (VV-ECMO) was started due to worsening blood gas parameters despite ventilatory management. Bronchoalveolar lavage fluid was serous, and both blood and sputum cultures yielded negative. The patient was weaned from VV-ECMO on day 26 as the pneumonia improved with recovery of hematopoiesis. She was disoriented, and a CT scan on day 28 revealed cerebral hemorrhage. Her strength recovered with rehabilitation. After induction chemotherapy, RUNX1::RUNX1T1 mRNA was not detected in bone marrow. The patient received consolidation chemotherapy, and has maintained complete remission. Severe respiratory failure during induction chemotherapy for acute leukemia can be fatal, but VV-ECMO may be lifesaving.
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Affiliation(s)
- Tadashi Okamura
- Department of Hematology/Oncology, Wakayama Medical University
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University
| | - Misato Tane
- Department of Hematology/Oncology, Wakayama Medical University
| | - Yuka Okabe
- Department of Hematology/Oncology, Wakayama Medical University
| | - Satomi Takeda
- Department of Hematology/Oncology, Wakayama Medical University
| | - Shotaro Tabata
- Department of Hematology/Oncology, Wakayama Medical University
| | - Hideki Kosako
- Department of Hematology/Oncology, Wakayama Medical University
| | - Yoshikazu Hori
- Department of Hematology/Oncology, Wakayama Medical University
| | | | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University
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Saravi B, Goebel U, Hassenzahl LO, Jung C, David S, Feldheiser A, Stopfkuchen-Evans M, Wollborn J. Capillary leak and endothelial permeability in critically ill patients: a current overview. Intensive Care Med Exp 2023; 11:96. [PMID: 38117435 PMCID: PMC10733291 DOI: 10.1186/s40635-023-00582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
Capillary leak syndrome (CLS) represents a phenotype of increased fluid extravasation, resulting in intravascular hypovolemia, extravascular edema formation and ultimately hypoperfusion. While endothelial permeability is an evolutionary preserved physiological process needed to sustain life, excessive fluid leak-often caused by systemic inflammation-can have detrimental effects on patients' outcomes. This article delves into the current understanding of CLS pathophysiology, diagnosis and potential treatments. Systemic inflammation leading to a compromise of endothelial cell interactions through various signaling cues (e.g., the angiopoietin-Tie2 pathway), and shedding of the glycocalyx collectively contribute to the manifestation of CLS. Capillary permeability subsequently leads to the seepage of protein-rich fluid into the interstitial space. Recent insights into the importance of the sub-glycocalyx space and preserving lymphatic flow are highlighted for an in-depth understanding. While no established diagnostic criteria exist and CLS is frequently diagnosed by clinical characteristics only, we highlight more objective serological and (non)-invasive measurements that hint towards a CLS phenotype. While currently available treatment options are limited, we further review understanding of fluid resuscitation and experimental approaches to target endothelial permeability. Despite the improved understanding of CLS pathophysiology, efforts are needed to develop uniform diagnostic criteria, associate clinical consequences to these criteria, and delineate treatment options.
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Affiliation(s)
- Babak Saravi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine, Medical Center, University of Freiburg, University of Freiburg, Freiburg, Germany.
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, St. Franziskus-Hospital, Muenster, Germany
| | - Lars O Hassenzahl
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University, Duesseldorf, Germany
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Aarne Feldheiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Evang. Kliniken Essen-Mitte, Huyssens-Stiftung/Knappschaft, University of Essen, Essen, Germany
| | - Matthias Stopfkuchen-Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Wollborn J, Zhang Z, Gaa J, Gentner M, Hausmann C, Saenger F, Weise K, Justice S, Funk JL, Staehle HF, Thomas M, Bruno RR, Saravi B, Friess JO, Marx M, Buerkle H, Trummer G, Muehlschlegel JD, Reker D, Goebel U, Ulbrich F. Angiopoietin-2 is associated with capillary leak and predicts complications after cardiac surgery. Ann Intensive Care 2023; 13:70. [PMID: 37552379 PMCID: PMC10409979 DOI: 10.1186/s13613-023-01165-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Patients undergoing cardiac surgery are prone to numerous complications. Increased vascular permeability may be associated with morbidity and mortality due to hemodynamic instability, fluid overload, and edema formation. We hypothesized that markers of endothelial injury and inflammation are associated with capillary leak, ultimately increasing the risk of postoperative complications. METHODS In this prospective, observational, multidisciplinary cohort study at our tertiary academic medical center, we recruited 405 cardiac surgery patients. Patients were assessed daily using body impedance electrical analysis, ultrasound, sublingual intravital microscopy, and analysis of serum biomarkers. Multivariable models, as well as machine learning, were used to study the association of angiopoietin-2 with extracellular water as well as common complications after cardiac surgery. RESULTS The majority of patients underwent coronary artery bypass grafting, valvular, or aortic surgeries. Across the groups, extracellular water increased postoperatively (20 ± 6 preoperatively to 29 ± 7L on postoperative day 2; P < 0.001). Concomitantly, the levels of the biomarker angiopoietin-2 rose, showing a strong correlation based on the time points of measurements (r = 0.959, P = 0.041). Inflammatory (IL-6, IL-8, CRP) and endothelial biomarkers (VE-Cadherin, syndecan-1, ICAM-1) suggestive of capillary leak were increased. After controlling for common risk factors of edema formation, we found that an increase of 1 ng/mL in angiopoietin-2 was associated with a 0.24L increase in extracellular water (P < 0.001). Angiopoietin-2 showed increased odds for the development of acute kidney injury (OR 1.095 [95% CI 1.032, 1.169]; P = 0.004) and was furthermore associated with delayed extubation, longer time in the ICU, and a higher chance of prolonged dependence on vasoactive medication. Machine learning predicted postoperative complications when capillary leak was added to standard risk factors. CONCLUSIONS Capillary leak and subsequent edema formation are relevant problems after cardiac surgery. Levels of angiopoietin-2 in combination with extracellular water show promising potential to predict postoperative complications after cardiac surgery. TRIAL REGISTRATION NUMBER German Clinical Trials Registry (DRKS No. 00017057), Date of registration 05/04/2019, www.drks.de.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany.
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Zilu Zhang
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Julie Gaa
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Gentner
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Hausmann
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Saenger
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karina Weise
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samuel Justice
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jean-Luca Funk
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans Felix Staehle
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marie Thomas
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Raphael R Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Babak Saravi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jan O Friess
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Markus Marx
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg Trummer
- Department of Cardiovascular Surgery, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jochen D Muehlschlegel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Daniel Reker
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Department of Anesthesiology and Critical Care, St. Franziskus-Hospital, Muenster, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felix Ulbrich
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kwon H, Odackal J, Husain M, Liebner DA. Sorafenib-Induced Capillary Leak Syndrome. Case Rep Oncol 2023; 16:1087-1094. [PMID: 37900814 PMCID: PMC10601792 DOI: 10.1159/000533957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 10/31/2023] Open
Abstract
Capillary leak syndrome is a rare life-threatening disorder of acute endothelial hyperpermeability. It consists of initial fluid extravasation resulting in hypotension, hypoalbuminemia, and hemoconcentration, followed by noncardiogenic pulmonary edema from rapid fluid remobilization into intravascular compartment. Drug-induced etiology is an important diagnostic consideration in cancer patients, particularly with use of antimetabolites, immunostimulants, and monoclonal antibodies. Sorafenib-mediated capillary leak syndrome has never been reported. Here, we present the case of a 29-year-old female patient with a desmoid tumor of the thigh, who was admitted for acute hypoxic respiratory failure after recent initiation of sorafenib. She was found to have extensive pulmonary edema, bilateral pleural effusions, and hemoconcentration, all of which stabilized on supportive care with noninvasive mechanical ventilation and intravenous diuresis. Her infectious and cardiac work-up were negative. Given the temporal relationship between sorafenib use and symptom onset as well as a lack of an alternative etiology of her findings, patient was deemed to have sorafenib-induced acute capillary leak syndrome. Importantly, she did not become hypotensive prior to or during this hospitalization. To our knowledge, we reported for the first time an atypical presentation of acute capillary leak syndrome due to sorafenib use without hemodynamic instability.
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Affiliation(s)
- Hyunwoo Kwon
- Physician Scientist Training Program, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John Odackal
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marium Husain
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David A. Liebner
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Velev M, Baroudjian B, Pruvost R, De Martin E, Laparra A, Babai S, Teysseire S, Danlos FX, Albiges L, Bernigaud C, Benderra MA, Pradère P, Zaidan M, Decroisette C, Fallah F, Matergia G, Lavaud P, Jantzem H, Atzenhoffer M, Buyse V, Ammari S, Robert C, Champiat S, Messayke S, Marabelle A, Guettier C, Lebbe C, Lambotte O, Michot JM. Immune-related generalised oedema - A new category of adverse events with immune checkpoint inhibitors. Eur J Cancer 2023; 179:28-47. [PMID: 36473326 DOI: 10.1016/j.ejca.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Generalised oedema was occasionally reported associated with immune checkpoint inhibitors (ICPIs). The purpose of this study is to investigate immune-related generalised oedema (ir-GE) drug related to ICPI, through frequency, clinical and pathological characteristics, and patient's outcome. PATIENTS AND METHODS Objectives of the study were to report on ir-GE associated with ICPI to define frequency, associated signs and symptoms, pathological characteristics, severity, and response to corticosteroids. To be included in the study, adult patients had to have ir-GE related to ICPI with certain or likely link, without any other known causes of generalised oedema. The study design was observational, over the period 2014-2020, from pharmacovigilance databases in France, including the prospective Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC) registry. Calculation of the frequency of ir-GE was restricted to the prospective REISAMIC registry. RESULTS Over 6633 screened patients, 20 had ir-GE confirmed drug related to ICPI. Based on the prospective REISAMIC registry, the frequency of ir-GE was 0.19% of ICPI-treated patients (3 cases out of 1598 screened patients). The 20 patients with ir-GE had a median (range) age of 62 (26-81) years, most frequent tumour types were melanoma (n = 9; 45%) and lung cancer (n = 6; 30%). The most frequent localisations of oedema were peripheral (n = 17; 85%), pleural (n = 13; 65%), and peritoneal (n = 10; 50%). Polyserositis was observed in 11 (55%) patients. The median (range) weight gain per patient was 9 (2-30) kg. Associated signs and symptoms met criteria for capillary leak syndrome (n = 4; 20%), sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) (n = 3; 15%), or subcutaneous autoimmune syndrome (n = 2; 10%). Corticosteroids were administered to 15 patients; of them, 10 (67%) improved clinically after corticosteroids. Based on CTCAEV5.0, the highest severity of ir-GE was grade ≥4 in 11 (55%) patients and four (20%) patients died due to ir-GE. CONCLUSIONS Generalised immune system-related oedema is a new category of adverse event with immune checkpoint inhibitors and is often associated with a life-threatening condition. The pathophysiology may in some cases be related to endothelial dysfunctions, such as SOS/VOD or capillary leak syndrome.
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Affiliation(s)
- Maud Velev
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Barouyr Baroudjian
- Assistance Publique - Hôpitaux de Paris, Saint-Louis Hospital, Dermatology Department, 75010 Paris, France
| | - Roxane Pruvost
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Eleonora De Martin
- Assistance Publique - Hôpitaux de Paris, Paul-Brousse Hospital, Department of Hepatology, Centre Hépato-Biliaire, INSERM 1193, 94800 Villejuif, France
| | - Ariane Laparra
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Samy Babai
- Assistance Publique - Hôpitaux de Paris, Henri Mondor Hospital, Department of Pharmacovigilance, 94000 Créteil, France
| | - Sandra Teysseire
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud Pierre Bénite, Department of Dermatology, 69002 Lyon, France
| | - François-Xavier Danlos
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Laurence Albiges
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Charlotte Bernigaud
- Assistance Publique - Hôpitaux de Paris, Henri Mondor Hospital, Dermatology Department, 94000 Créteil, France
| | - Marc-Antoine Benderra
- Assistance Publique - Hôpitaux de Paris, Tenon Hospital, Department of Medical Oncology, 75020 Paris, France
| | - Pauline Pradère
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France
| | - Mohamad Zaidan
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Nephrology Department, 94270 Le Kremlin-Bicêtre, France
| | - Chantal Decroisette
- Centre Hospitalier Annecy Genevois, Department of Medical Oncology, 74374 Pringy, France
| | - Fatma Fallah
- Centre Hospitalier Argenteuil, Department of Medical Oncology, 95107 Argenteuil, France
| | - Gaelle Matergia
- Hôpital-Clinique Claude Bernard, Department of Medical Oncology, 57070 Metz, France
| | - Pernelle Lavaud
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Hélène Jantzem
- Centre Hospitalier Universitaire de Brest, Department of Pharmacovigilance, Centre Régional de Pharmacovigilance, 29609 Brest, France
| | - Marina Atzenhoffer
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud Pierre Bénite, Department of Clinical Pharmacology and Pharmacovigilance, 69002 Lyon, France
| | - Véronique Buyse
- O.L.V. van Lourdes Ziekenhuis Waregem, Vijfseweg 150, 8790 Waregem, Belgium; Oncologie, Vijfseweg 150, B-8790 Waregem, Belgium
| | - Samy Ammari
- Gustave Roussy - Paris-Saclay University, Radiology Department, 94800 Villejuif, France
| | - Caroline Robert
- Gustave Roussy - Paris-Saclay University, Department of Medical Oncology, 94800 Villejuif, France
| | - Stéphane Champiat
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Sabine Messayke
- Gustave Roussy - Paris-Saclay University, Pharmacovigilance Unit, 94800 Villejuif, France
| | - Aurélien Marabelle
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France
| | - Catherine Guettier
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Department of Pathology, UMR-S 1193, 94270 Le Kremlin Bicêtre, France
| | - Céleste Lebbe
- Assistance Publique - Hôpitaux de Paris, University of Paris, Department of Dermatology, DMU ICARE, Saint Louis Hospital, INSERM U976 HIPI, Team 1, F-75010 Paris, France
| | - Olivier Lambotte
- Assistance Publique - Hôpitaux de Paris, Paris-Saclay University, Bicêtre Hospital, Internal Medicine Department, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Marie Michot
- Gustave Roussy - Paris-Saclay University, Département d'Innovation Thérapeutique et Essais Précoces, 94800 Villejuif, France; Gustave Roussy, INSERM U1170, Université Paris-Saclay, Villejuif, France.
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Petitdemange A, Béguin L, Dimitrov Y. Immune checkpoint inhibitors-induced systemic capillary leak syndrome: A report of two cases. Rev Med Interne 2023; 44:35-7. [PMID: 36404226 DOI: 10.1016/j.revmed.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 10/18/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The occurrence of systemic capillary leak syndrome under immune checkpoint inhibitors has seldom been reported in the literature. OBSERVATION We report two cases of systemic capillary leak syndrome that occurred with nivolumab (anti-PD-1 antibody) for one, and with an anti-PD-1/CTLA-4 bi-specific antibody for the other. Patients presented with anasarca, hypoalbuminemia, acute kidney injury and, in one case, circulatory collapse. Immune checkpoint inhibitor causality was retained in the lack of evidence for other causes of secondary capillary leak syndrome or for an idiopathic form. The symptoms resolved after a few days of supportive measures (associated with glucocorticoids in one case). DISCUSSION A high index of suspicion is required for the diagnosis of immune checkpoint inhibitors-induced systemic capillary leak syndrome because its presentation may differ from that of the idiopathic form. Activated CD8+ T-cells play a prominent role in the occurrence of immune checkpoint inhibitors-induced capillary leakage via their cytolytic action on the vascular endothelium. Treatment relies on supportive measures and discontinuation of the immune checkpoint inhibitor while the place of immunomodulatory drugs remains to be defined.
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Johansen S, Blomberg B, Vo AK, Wendelbo Ø, Reikvam H. Weight gain during treatment course of allogenic hematopoietic stem cell transplantation in patients with hematological malignancies affects treatment outcome. Cytotherapy 2022; 24:1190-1194. [PMID: 36151003 DOI: 10.1016/j.jcyt.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/11/2022] [Accepted: 08/18/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AIMS Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for patients with hematological malignancies; however, allo-HSCT does not come without the cost of treatment-related morbidity and mortality. Early detection of risk factors could be helpful in identifying patients who could benefit from early interventions. Many patients gain weight during the allo-HSCT treatment, although little is known about the impact of weight gain. METHODS Weight gain in 146 consecutively enrolled adult patients undergoing allo-HSCT was explored. RESULTS In total, 141 patients (97%) gained weight along the course of allo-HSCT. Median weight increase was 4.8 kg (range 0.0-16.1 kg), with median increase in body weight 6.5% (range 0.0%-30.8%). Maximum weight increase was observed at day +7 (range day -8, +44). Weight gain was associated with increased incidence of acute graft-versus-host disease. Patients with weight gain >10% had a significantly greater 5-year mortality compared with those with lower weight gain (P = 0.031, rank sum test). CONCLUSIONS Weight gain is a simple variable with the ability to provide prognostic information for patients undergoing allo-HSCT.
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Affiliation(s)
- Silje Johansen
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anh Khoi Vo
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Øystein Wendelbo
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; VID Specialized University, Faculty of Health, Bergen, Norway
| | - Håkon Reikvam
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
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9
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Hariharan AS, Gopalakrishnan S, Abraham B. Capillary leak syndrome due to Russell's viper envenomation-A doomy presage for treating clinician. J Family Med Prim Care 2022; 11:5670-5672. [PMID: 36505542 PMCID: PMC9731082 DOI: 10.4103/jfmpc.jfmpc_2385_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022] Open
Abstract
Russell's viper envenomation is a major challenge to physicians providing intensive care due to diverse presentations and dismal outcomes. The venom can cause idiopathic systemic capillary leak syndrome manifesting with bilateral parotid swelling, hemoconcentration, and refractory shock. Physicians' awareness about this presentation is lacking. Delayed recognition of this syndrome leads to fatalities despite providing the best possible care. We hereby report a fatal case of Daboia russelii bite presenting as capillary leak syndrome. The aim is to create awareness among tropical physicians who are primary caregivers to these victims.
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Affiliation(s)
- A S Hariharan
- Department of General Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India,Address for correspondence: Dr. Hariharan A S, Department of General Medicine, Government Villupuram Medical College and Hospital, Villupuram - 605602, Tamil Nadu, India. E-mail:
| | - Shivkumar Gopalakrishnan
- Department of General Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
| | - Bobby Abraham
- Department of General Medicine, Government Villupuram Medical College and Hospital, Villupuram, Tamil Nadu, India
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10
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Juneja D, Kataria S. Capillary leak syndrome: A rare cause of acute respiratory distress syndrome. World J Clin Cases 2022; 10:4324-4326. [PMID: 35665129 PMCID: PMC9131229 DOI: 10.12998/wjcc.v10.i13.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
Capillary leak syndrome (CLS) is a rare clinical syndrome associated with significant morbidity and mortality. Intensive care and supportive therapy constitute the mainstay of the treatment, along with judicious use of crystalloids and colloids such as dextran and starch during the leak phase. The advantages of proning, steroids, and intravenous immunoglobins are worth contemplating in patients with such a presentation. Extracorporeal membrane oxygenation appears to be an excellent strategy to surmount the impediments of the leak and post leak phase of CLS, especially in patients with severe or refractory hypoxemia.
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Affiliation(s)
- Deven Juneja
- Department ofCritical Care Medicine, Max Super Speciality Hospital, Delhi 110017, India
| | - Sahil Kataria
- Department ofCritical Care Medicine, Max Super Speciality Hospital, Delhi 110017, India
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11
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Wollborn J, Hassenzahl LO, Reker D, Staehle HF, Omlor AM, Baar W, Kaufmann KB, Ulbrich F, Wunder C, Utzolino S, Buerkle H, Kalbhenn J, Heinrich S, Goebel U. Diagnosing capillary leak in critically ill patients: development of an innovative scoring instrument for non-invasive detection. Ann Intensive Care 2021; 11:175. [PMID: 34910264 PMCID: PMC8674404 DOI: 10.1186/s13613-021-00965-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The concomitant occurrence of the symptoms intravascular hypovolemia, peripheral edema and hemodynamic instability is typically named Capillary Leak Syndrome (CLS) and often occurs in surgical critical ill patients. However, neither a unitary definition nor standardized diagnostic criteria exist so far. We aimed to investigate common characteristics of this phenomenon with a subsequent scoring system, determining whether CLS contributes to mortality. METHODS We conducted this single-center, observational, multidisciplinary, prospective trial in two separately run surgical ICUs of a tertiary academic medical center. 200 surgical patients admitted to the ICU and 30 healthy volunteers were included. Patients were clinically diagnosed as CLS or No-CLS group (each N = 100) according to the grade of edema, intravascular hypovolemia, hemodynamic instability, and positive fluid balance by two independent attending physicians with > 10 years of experience in ICU. We performed daily measurements with non-invasive body impedance electrical analysis, ultrasound and analysis of serum biomarkers to generate objective diagnostic criteria. Receiver operating characteristics were used, while we developed machine learning models to increase diagnostic specifications for our scoring model. RESULTS The 30-day mortility was increased among CLS patients (12 vs. 1%, P = 0.002), while showing higher SOFA-scores. Extracellular water was increased in patients with CLS with higher echogenicity of subcutaneous tissue [29(24-31) vs. 19(16-21), P < 0.001]. Biomarkers showed characteristic alterations, especially with an increased angiopoietin-2 concentration in CLS [9.9(6.2-17.3) vs. 3.7(2.6-5.6)ng/mL, P < 0.001]. We developed a score using seven parameters (echogenicity, SOFA-score, angiopoietin-2, syndecan-1, ICAM-1, lactate and interleukin-6). A Random Forest prediction model boosted its diagnostic characteristics (AUC 0.963, P < 0.001), while a two-parameter decision tree model showed good specifications (AUC 0.865). CONCLUSIONS Diagnosis of CLS in critically ill patients is feasible by objective, non-invasive parameters using the CLS-Score. A simplified two-parameter diagnostic approach can enhance clinical utility. CLS contributes to mortality and should, therefore, classified as an independent entity. TRIAL REGISTRATION German Clinical Trials Registry (DRKS No. 00012713), Date of registration 10/05/2017, www.drks.de.
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Affiliation(s)
- Jakob Wollborn
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany. .,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Lars O Hassenzahl
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Daniel Reker
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Hans Felix Staehle
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Anne Marie Omlor
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wolfgang Baar
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai B Kaufmann
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Felix Ulbrich
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christian Wunder
- Department of Anesthesiology and Critical Care, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Stefan Utzolino
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hartmut Buerkle
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Sebastian Heinrich
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ulrich Goebel
- Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany.,Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Anesthesiology and Critical Care, St. Franziskus-Hospital, Muenster, Germany
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12
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Lingam TMC, Tan KY, Tan CH. Capillary leak syndrome induced by the venoms of Russell's Vipers (Daboia russelii and Daboia siamensis) from eight locales and neutralization of the differential toxicity by three snake antivenoms. Comp Biochem Physiol C Toxicol Pharmacol 2021; 250:109186. [PMID: 34508870 DOI: 10.1016/j.cbpc.2021.109186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
Snakebite envenomation caused by the Western and Eastern Russell's Vipers (Daboia russelii and Daboia siamensis) may potentially induce capillary leak syndrome (CLS), while the use of antivenom in treating this has not been well examined. This study investigated the CLS-inducing toxicity of Russell's Viper venoms from various sources and examined the neutralization activity of regionally available antivenoms, using a newly devised mouse model. D. russelii venoms demonstrated a more consistent vascular leakage activity (76,000-86,000 CLS unit of vascular leak index, a function of the diameter and intensity of Evans Blue dye extravasation into dermis) than D. siamensis venoms (33,000-88,000 CLS unit). Both species venoms increased hematocrits markedly (53-67%), indicating hemoconcentration. Regional antivenoms (DsMAV-Thailand, DsMAV-Taiwan, VPAV-India) preincubated with the venoms effectively neutralized the CLS effect to different extents. When the antivenoms were administered intravenously post-envenomation (challenge-rescue model), the neutralization was less effective, implying that CLS has a rapid onset that preceded the neutralizing activity of antivenom, and/or the antivenom has limited biodistribution to the venom's inoculation site. In conclusion, Russell's Viper venoms of both species from various locales induced CLS in mice. Antivenoms generally had limited efficacy in neutralizing the CLS effect. Innovative treatment for venom-induced CLS is needed.
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Affiliation(s)
- Thava Malar Changra Lingam
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kae Yi Tan
- Protein and Interactomics Laboratory, Department of Molecular Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Choo Hock Tan
- Venom Research and Toxicology Laboratory, Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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13
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Vázquez-Arredondo JG, Vázquez-Rodríguez JG. Plasma colloid osmotic pressure in preeclampsia. Review of the Mexican literature 1997-2018. CIR CIR 2021; 89:547-552. [PMID: 34352863 DOI: 10.24875/ciru.19001263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
En México, la presión coloidosmótica del plasma ha sido un tema clave del estudio de la mujer embarazada por más de dos décadas. Las investigaciones clínicas han permitido conocer sus valores en población abierta, mujeres con embarazo normal, puerperio fisiológico, preeclampsia severa, síndrome HELLP y eclampsia. También se ha reportado la relación de la presión coloidosmótica del plasma con la presión sanguínea (índice de Briones), síndrome de fuga capilar y la acumulación de líquido en cavidades serosas (derrame pleural, ascitis). Revisamos la base de datos PubMed, The Cochrane Library, OVID, Science Direct, Google Scholar, Artemisa, LILACS e IMBIOMED de 1997 a 2018 con las siguientes palabras clave: albúmina sérica, presión coloidosmótica del plasma, síndrome de fuga capilar, índice de Briones, derrame pleural, ascitis, preeclampsia severa, síndrome HELLP, eclampsia y cuidados críticos en obstetricia. Los criterios de inclusión fueron revisiones sistemáticas, meta-análisis, ensayos clínicos controlados y artículos con metodología de medicina basada en evidencia con recomendaciones sólidas. Incluimos 12 artículos mexicanos. Los objetivos de la presente investigación fueron: revisar la literatura médica de la presión coloidosmótica del plasma en preeclampsia reportada de 1997 a 2018, describir el tratamiento con albúmina humana y las perspectivas de la investigación en los siguientes años. In Mexico, plasma colloid osmotic pressure has been a key issue in the study of pregnant women for more than two decades. Clinical investigations have allowed to know their values in the open population, as well as in women with normal pregnancy, physiological puerperium, severe preeclampsia, HELLP syndrome, and eclampsia. The relationship of plasma colloid osmotic pressure with mean arterial pressure (Briones index), capillary leak syndrome and the accumulation of fluid in serous cavities (pleural effusion, and ascites) have also been reported. We reviewed the database of PubMed, The Cochrane Library, OVID, Science Direct, Google Scholar, Artemisa, LILACS, and IMBIOMED from 1997 to 2018 with the following keywords: serum albumin, plasma colloid osmotic pressure, capillary leak syndrome, Briones index, pleural effusion, ascites, severe preeclampsia, HELLP syndrome, eclampsia, and obstetrics critical care. Inclusion criteria were systematic reviews, meta-analysis, clinical controlled trials, and articles with evidence-based medicine methodology with strong recommendations. We included 12 Mexican articles. The objectives of the present investigation were to review the medical literature on plasma colloid osmotic pressure in preeclampsia reported from 1997 to 2018, describe the treatment with human albumin and the perspectives of the research in the following years.
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Affiliation(s)
| | - Juan G Vázquez-Rodríguez
- Unit of Intensve Care, Unidad Médica de Alta Especialida, Hospital de Ginecología y Obstetricia No. 3, Centro Médico Nacional "La Raza," Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Yang LF, Ding JC, Zhu LP, Li LX, Duan MQ, Chen ZG, Tang XY, Li YT. Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report. Ital J Pediatr 2021; 47:116. [PMID: 34039399 PMCID: PMC8157435 DOI: 10.1186/s13052-021-01067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Capillary leak syndrome (CLS) is a rare disease characterized by profound vascular leakage and presents as a classic triad of hypotension, hypoalbuminemia and hemoconcentration. Severe CLS is mostly induced by sepsis and generally life-threatening in newborns, especially in premature infants. Continuous renal replacement therapy (CRRT) plays an important role of supportive treatment for severe CLS. Unfortunately, CRRT in preterm infants has rarely been well defined. CASE PRESENTATION We report the case of a 11-day-old girl with CLS caused by sepsis, who was delivered by spontaneous vaginal delivery (SVD) at gestational age of 25 weeks and 4 days, and a birth weight of 0.89 Kilograms(kg). The infant received powerful management consisting of united antibiotics, mechanical ventilation, intravenous albumin and hydroxyethyl starch infusion, vasoactive agents, small doses of glucocorticoids and other supportive treatments. However, the condition rapidly worsened with systemic edema, hypotension, pulmonary exudation, hypoxemia and anuria in about 40 h. Finally, we made great efforts to perform CRRT for her. Fortunately, the condition improved after 82 h' CRRT, and the newborn was rescued and gradually recovered. CONCLUSION CRRT is an effective rescue therapeutic option for severe CLS and can be successfully applied even in extremely-low-birth-weight premature.
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Affiliation(s)
- Li-Fen Yang
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Jia-Chang Ding
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Ling-Ping Zhu
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Li-Xia Li
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Meng-Qi Duan
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Zhuang-Gui Chen
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China
| | - Xin-Yi Tang
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China.
| | - Ya-Ting Li
- Pediatric Intensive Care Unit, Department of Pediatrics, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, P.R. China.
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16
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Noure L, Küçük K, Simeni Njonnou SR, Del Marmol V, White JM, Bondue B. Respiratory Distress Syndrome Associated with Erythrodermic Psoriasis. Case Rep Dermatol 2021; 13:83-88. [PMID: 33708088 PMCID: PMC7923713 DOI: 10.1159/000511368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
Erythrodermic psoriasis is an uncommon and severe variant of psoriasis which may be associated with rare and severe complications such as acute respiratory distress syndrome. Early recognition of this life-threatening condition can allow prompt appropriate treatment. We report the case of a 69-year-old man with a long history of psoriasis who developed acute respiratory distress during a disease flare-up. There was no relevant past history (except for mild emphysema), known allergy, or recent treatment. Chest X-ray revealed new bilateral infiltrates, confirmed at chest computed tomography scan. Repeated cultures on aspirate of the bronchoalveolar lavage remained negative for viruses, bacteria, and parasites. Cardiac ultrasound was normal and high-dose corticosteroid therapy was initiated. Within a few days his clinical and radiological status improved significantly.
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Affiliation(s)
- Lamya Noure
- Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Kirley Küçük
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvain Raoul Simeni Njonnou
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Department of Internal Medicine and Specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Véronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan M White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Benjamin Bondue
- Department of Pneumology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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17
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Park JW, Seo J, Kim SH, Jung KT. Capillary leak syndrome and disseminated intravascular coagulation after kidney transplantation in a patient with hereditary angioedema - A case report. Anesth Pain Med (Seoul) 2021; 16:75-80. [PMID: 33530679 PMCID: PMC7861902 DOI: 10.17085/apm.20098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hereditary angioedema (HAE) is a rare disease caused by the deficiency of C1 esterase inhibitor. HAE has a risk of life-threatening complications such as capillary leak syndrome (CLS) and disseminated intravascular coagulation (DIC). Case A 42-year-old male patient with HAE presented for deceased-donor kidney transplantation. Prophylactic fresh frozen plasma (FFP) was given before surgery because of the risk of edema development. With careful management during anesthesia, there were no problems during surgery. However, generalized edema, hypotension, hypoalbuminemia, massive drainage of serosanguineous fluids from the intraabdominal space, and DIC occurred on the day after surgery. CLS was suspected and sustained hypotension with generalized edema became worse despite treatment with albumin, danazol, FFP, and vasoactive drugs. The patient’s condition worsened despite intensive care and he died due to shock. Conclusions The anesthesiologist should prepare for the critical complications of HAE and prepare the appropriate treatment options.
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Affiliation(s)
- Jeong Wook Park
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Medicine, Graduate School, Chosun University, Gwangju, Korea
| | - Jinyoung Seo
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
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18
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Massafra M, Passalacqua MI, Lupo G, Altavilla G, Santarpia M. Capillary leak syndrome induced by neoadjuvant cisplatin and gemcitabine in a patient with bladder cancer. Urol Case Rep 2021; 34:101461. [PMID: 33101987 DOI: 10.1016/j.eucr.2020.101461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Capillary leak syndrome (CLS) is a rare disorder associated with an increased capillar permeability due to an endothelial damage, causing leakage of plasma and proteins into the interstitial compartment. CLS is characterized by rapidly developing edema, hypotension and hypoproteinemia. We observed CLS in a 54-year-old man affected by muscle-invasive bladder cancer who received neoadjuvant treatment with Cisplatin and Gemcitabine. Treatment with infusion of albumin and increasing corticosteroid doses and diuretics led to a complete regression of all signs and symptoms related to the disorder. Of note, the patient showed an objective complete response to chemotherapy and underwent radical surgery on schedule.
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Man C, Wang M, Yin G, Huang J, Cheng W, Wu X, Liu L, Gao X, Wang J, Tian T, Duan L, Xu J, Qiu H. Clinical features of 47 secondary hemophagocytic lymphohistiocytosis patients complicated with capillary leak syndrome. Int J Hematol 2020; 113:263-270. [PMID: 33037588 PMCID: PMC7546163 DOI: 10.1007/s12185-020-03011-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022]
Abstract
The clinical features of patients with secondary hemophagocytic lymphohistiocytosis (sHLH) complicated with capillary leak syndrome (CLS) remain controversial. The data of 259 sHLH patients were retrospectively analyzed. The clinical manifestations, laboratory findings, treatment, and prognosis of the CLS-sHLH group and non-CLS-sHLH group were compared. The levels of fibrinogen, albumin, and serum calcium in the CLS-sHLH group were lower than in the non-CLS-sHLH group, and serum triglycerides in the CLS-sHLH group were higher than in the non-CLS-sHLH group (P < 0.05). Univariate analysis showed that fibrinogen level was an independent prognostic factor in sHLH patients complicated with CLS. The median survival time was significantly shorter in patients with fibrinogen ≤ 1.3 g/L than in patients with fibrinogen > 1.3 g/L (P < 0.05). Patients with improved CLS conditions in the CLS-sHLH group had significantly increased albumin and serum calcium after treatment (P < 0.05); patients without improved conditions in the CLS-sHLH group also had significantly increased albumin after treatment (P < 0.05), but the serum calcium did not change significantly (P > 0.05). sHLH patients complicated with CLS had significantly worse prognosis than without CLS. Significant reduction in fibrinogen may be an independent prognostic factor for poor prognosis in sHLH patients complicated with CLS.
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Affiliation(s)
- Changfeng Man
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Mengmeng Wang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Guangli Yin
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jiayu Huang
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Wanying Cheng
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xing Wu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Lingling Liu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Xin Gao
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jujuan Wang
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Tian Tian
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Limin Duan
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Ji Xu
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hongxia Qiu
- Department of Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
- Department of Geriatric Hematology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
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Di Maso V, Cozzi M, Gerini U, Bedina E, Olivo E, Bianco F, Signoretto D, Berlot G, Boscutti G. Coupled Plasma Filtration Adsorption for Treatment of Capillary Leak Syndrome Superimposed to Acute Generalized Exanthematous Pustolosis: A Case Report. Blood Purif 2020; 49:372-378. [PMID: 32069462 DOI: 10.1159/000503770] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/28/2019] [Indexed: 11/19/2022]
Abstract
Coupled plasma filtration adsorption (CPFA) is an extracorporeal supportive therapy based on nonspecific adsorption of pro- and anti-inflammatory mediators combined with continuous renal replacement therapy. The main field of CPFA application is septic shock, and there are limited data about its efficacy in the treatment of other acute conditions characterized by a dysregulation in immune homeostasis. Capillary leak syndrome (CLS) defines a life-threatening condition sustained by hypercytokinemia and characterized by abrupt onset of increased capillary permeability leading to severe generalized edema and hypovolemic shock refractory to fluid administration. Therapy for CLS is not specific and, at present time, it consists in the use of steroids or intravenous immunoglobulins. We present the case of a 34-year-old woman who developed CLS superimposed to acute generalized exanthematous pustulosis after initiating therapy with hydroxychloroquine for undifferentiated connective tissue disease. CLS did not respond to steroids and intravenous immunoglobulins, while it was successfully treated with CPFA. This observation supports the possible role of CPFA in restoring a proper immunologic homeostasis not only in sepsis but also in other devastating conditions sustained by hypercytokinemia.
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Affiliation(s)
- Vittorio Di Maso
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy,
| | - Martina Cozzi
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
| | - Ugo Gerini
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
| | - Elisa Bedina
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
| | - Elisa Olivo
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
| | - Francesco Bianco
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
| | | | - Giorgio Berlot
- Department of Perioperative Medicine, Intensive Care and Emergency, ASUITS, Trieste, Italy
| | - Giuliano Boscutti
- Nephrology and Dialysis Unit, Department of Internal Medicine, ASUITS, Trieste, Italy
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Zhang YT, Zhang L, Yao YM, Zhong XD, Chang J. Unexpected vincristine-induced systemic capillary leak syndrome in patients with Wilm's tumor: A single institution experience. Pediatr Hematol Oncol 2020; 37:90-96. [PMID: 31868068 DOI: 10.1080/08880018.2019.1685031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Capillary leak syndrome (CLS) is a rare but fatal disease, which has been reported following the infusions of interleukin-2, tumor necrosis factor, granulocyte-colony stimulating factor, certain monoclonal antibodies, and gemcitabine, suggesting that drugs can also cause CLS. In this study, seven Wilm's tumor cases with CLS had been presented, which was suggested to be caused following administration of vincristine (VCR). From January 1st, 2014 to December 31st, 2016, medical records from Wilm's tumor patients were reviewed to identify those diagnosed with CLS. Moreover, the following data were extracted for each patient, including age, gender, histological subtyping, tumor stage, risk group, biomarkers, chemotherapy regimen and dosage, surgery details, clinical manifestation of CLS, treatment regimen of CLS, and patient outcomes. From January 1st, 2014 to December 31st, 2016, a total of seven patients with Wilms tumor were identified with a diagnosis of VCR-associated CLS. Typically, for these seven cases in our study, the predominant features of CLS included interstitial pneumonia and pulmonary edema. Moreover, steroid therapy was demonstrated as the most effective therapy in our study. The clinical features of VCR-induced CLS are distinct, and pediatric oncologists should be aware of CLS that manifests as interstitial pneumonia and pulmonary edema during the VCR treatment for patients with Wilm's tumor.
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Affiliation(s)
- Yu-Tong Zhang
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lei Zhang
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yun-Ming Yao
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Dan Zhong
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jian Chang
- The First Hospital of Jilin University, Changchun, Jilin, China
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Igeta R, Hsu HC, Suzuki M, Lefor AT, Tsukuda J, Endo T, Tanii R, Taira Y, Fujitani S. Compartment syndrome due to Capnocytophaga canimorsus infection: a case report. Acute Med Surg 2020; 7:e474. [PMID: 31988786 PMCID: PMC6971439 DOI: 10.1002/ams2.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/29/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022] Open
Abstract
Background Purpura fulminans secondary to Capnocytophaga canimorsus (C. canimorsus) infection without a wound is rare and often misdiagnosed initially. We report a patient who died due to C. canimorsus bacteremia with purpura fulminans and acute compartment syndrome of all extremities. Care Presentation A 38‐year‐old Japanese man with a history of alcoholism presented with a 2‐day history of gastroenteritis. The chief complaints were abdominal pain and diarrhea, and he had abdominal tenderness. Laboratory findings showed multiple organ failure. On day 2, pain in the lower extremities associated with motor and sensory dysfunction developed. On day 3, purpura on the whole body spread to all extremities. All four extremities became rigid, and acute compartment syndrome developed. The patient died due to uncontrolled hyperkalemia and lactic acidosis. Conclusions Capnocytophaga canimorsus transmission can occur through licking or even close contact with animals when a risk factor of C. canimorsus infection, such as alcoholism, is present.
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Affiliation(s)
- Ryuhei Igeta
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
| | - Hsiang-Chin Hsu
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan.,Department of Emergency Medicine College of Medicine National Cheng Kung University Hospital National Cheng Kung University Tainan City Taiwan
| | - Michio Suzuki
- Department of Veterinary Science National Institute of Infectious Diseases Tokyo Japan
| | - Alan T Lefor
- Department of Gastrointestinal Surgery Jichi Medical University Tochigi Japan
| | - Jumpei Tsukuda
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
| | - Takuro Endo
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
| | - Rimi Tanii
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
| | - Yasuhiko Taira
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine St. Marianna University Hospital Kanagawa Japan
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Igata Y, Okubo S, Ohkura Y, Ueno M, Udagawa H. Anasarca, steatorrhea, and hypoalbuminemia 18 years after total gastrectomy: a case report. Surg Case Rep 2019; 5:155. [PMID: 31650279 PMCID: PMC6813405 DOI: 10.1186/s40792-019-0721-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/27/2019] [Indexed: 11/12/2022] Open
Abstract
Background Pancreatic exocrine insufficiency (PEI) is known to occur after total gastrectomy. We experienced a case of PEI occurring 18 years after surgery, leading to a potentially fatal condition of capillary leak syndrome (CLS). Case presentation The case is a 58-year-old man on a healthy diet who underwent total gastrectomy 18 years before. He was admitted for a 3-month history of anasarca, steatorrhea, and hypoalbuminemia. An episode of fever occurred during workup, followed by pulmonary edema and shock. The patient was transferred to the intensive care unit and was started on fluid management with albumin infusion. A multidisciplinary team meeting was held, and a clinical diagnosis of PEI resulted in CLS was made and we started administration of oral pancrelipase to show clinical improvement. The patient was discharged, and he remained asymptomatic for 13 months. Conclusion In a post-gastrectomy patient with malnutrition, PEI should be suspected regardless of the period since surgery. When recognized, immediate replenishment of albumin and pancreatic enzymes should be initiated to prevent clinical deterioration.
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Affiliation(s)
- Yu Igata
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - So Okubo
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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Wang MM, Qiu HX, Wang JJ, Gao X, Duan LM, Tian T, Cheng WY, Liu LL. [Clinical analysis of secondary hemophagocytic lymphohistiocytosis complicated with capillary leak syndrome]. Zhonghua Xue Ye Xue Za Zhi 2019; 40:502-506. [PMID: 31340624 PMCID: PMC7342403 DOI: 10.3760/cma.j.issn.0253-2727.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 探讨继发性噬血细胞性淋巴组织细胞增多症(sHLH)合并毛细血管渗漏综合征(CLS)的临床特征。 方法 回顾性分析2015年1月至2017年12月江苏省人民医院收治的87例sHLH患者的临床及实验室资料,其中21例合并CLS(CLS-sHLH组),66例未合并CLS(非CLS-sHLH组)。比较两组的临床表现、实验室检查、治疗及预后差异。 结果 比较CLS-sHLH组和非CLS-sHLH组患者引起sHLH的病因,差异无统计学意义(P>0.05)。CLS-sHLH组患者ANC、血清纤维蛋白原、白蛋白较非CLS-sHLH组降低,而甘油三酯较非CLS-sHLH组升高(P值均<0.05)。CLS-sHLH组患者均有不同程度水肿、体重增加、低血压、低蛋白血症、少尿及多浆膜腔积液。其中15例患者CLS症状消失,CLS中位好转时间为7(5~14)d。6例患者CLS症状未消失,并于15(6~30)d死亡。CLS-sHLH组中位OS时间低于非CLS-sHLH组(75 d对未达到,P=0.031)。 结论 在sHLH患者中,CLS的发生可能与sHLH的原发病无明显相关。严重的ANC、纤维蛋白原及白蛋白减低,甘油三酯升高,可能是sHLH发生CLS的伴随症状。sHLH合并CLS时预后差。
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Affiliation(s)
- M M Wang
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - H X Qiu
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - J J Wang
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - X Gao
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L M Duan
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - T Tian
- Department of Geriatric Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - W Y Cheng
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
| | - L L Liu
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China
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Alkhunaizi AM, Kabbani AH, ElTigani MA. Chronic idiopathic systemic capillary leak syndrome: a case report. Allergy Asthma Clin Immunol 2019; 15:34. [PMID: 31160895 PMCID: PMC6540441 DOI: 10.1186/s13223-019-0347-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 05/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic systemic capillary leak syndrome (ISCLS), is a rare disorder characterized by recurrent attacks of varying severity of hypovolemic shock and generalized edema in association with hemoconcentration and hypoalbuminemia in the absence of albuminuria. The chronic form of ISCLS is extremely rare with only a few cases reported in the literature. Case presentation Here we report the case of a young woman who developed chronic ISCLS characterized by massive, generalized and persistent edema. The work up confirmed the presence of monoclonal gammopathy. She was treated with several agents with no response. Conclusion Chronic ISCLS is a very rare disease of unknown etiology and results in devastating complications. The medical community should be aware of this disease with the hope that targeted therapy will become available in the future.
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Affiliation(s)
- Ahmed M Alkhunaizi
- 1Nephrology Section, Internal Medicine Services Division, Johns Hopkins Aramco Healthcare, Saudi Aramco, Box 10955, Dhahran, 31311 Saudi Arabia
| | - Abdullah H Kabbani
- 3Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohamed A ElTigani
- 2General Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Whayne TF, Fisher MB. Idiopathic "Cyclic" Edema: A Frustrating and Poorly Understood Clinical Problem. Cardiovasc Hematol Agents Med Chem 2018; 16:88-93. [PMID: 30539703 DOI: 10.2174/1871525717666181211141227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/03/2018] [Accepted: 12/05/2018] [Indexed: 11/22/2022]
Abstract
Idiopathic Edema (IE), is a syndrome involving real or perceived weight gain secondary to the pathological retention of fluid. This syndrome of generalized edema is almost solely reported in women. The diagnosis of IE is one of exclusion and requires a careful history, physical exam, and clinical suspicion. The aim of this article is to provide a comprehensive review of the available literature in order to attempt to define IE, identify the possible causes, review the proposed pathophysiology, and discuss potential treatment options.
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Affiliation(s)
- Thomas F Whayne
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, United States
| | - Mary B Fisher
- Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, United States
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27
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Kitano M, Hoashi T, Kakuta T, Fujimoto K, Miyake A, Kurosaki KI, Ichikawa H, Shiraishi I. Primary Draining Vein Stenting for Obstructive Total Anomalous Pulmonary Venous Connection in Neonates with Right Atrial Isomerism and Functional Single Ventricle Improves Outcome. Pediatr Cardiol 2018; 39:1355-1365. [PMID: 29777280 DOI: 10.1007/s00246-018-1902-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
For neonates with right atrial isomerism (RAI), functional single ventricle (f-SV), and obstructive total anomalous pulmonary venous connection (TAPVC), primary TAPVC repair (TAPVCR) has a poor outcome. At our hospital, the survival rate at 1 year of such neonates undergoing primary TAPVCR between 1999 and 2010 (TAPVCR group) was 30% (3/10). Most deceased cases suffered from capillary leak syndrome and unstable pulmonary resistance after the surgeries. We sought to determine whether less invasive primary draining vein stenting (DVS) improved the outcome of these neonates. We investigated outcomes in consecutive nine such neonates (median gestational age 38 weeks, birth weight 2.8 kg, females 4) who underwent primary DVS with 6-mm-diameter Palmaz® Genesis® stents at our hospital between 2007 and 2017 (DVS group). Eight patients underwent subsequent surgeries to adjust the pulmonary flow after decreased pulmonary resistance. The survival rate at 1 year after the first interventions in the DVS group improved to 77% (7/9), although there was a difference between the interventional eras of the two groups. Of the seven patients who underwent multiple stent redilations with a larger balloon or additional stenting in other sites until the next stage of surgery at a median age of 8 months, four received a bidirectional Glenn (BDG) shunt and TAPVCR and three underwent TAPVCR, with two of those cases reaching BDG. Less invasive primary DVS improved the outcome of neonates with RAI, f-SV, and obstructive TAPVC, with many reaching BDG. Patient selection to advance toward Fontan is thought to further improve the outcome.
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Affiliation(s)
- Masataka Kitano
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
| | - Takaya Hoashi
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takashi Kakuta
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuto Fujimoto
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akira Miyake
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ken-Ichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hazime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Bozzini MA, Milani GP, Bianchetti MG, Fossali EF, Lava SAG. Idiopathic systemic capillary leak syndrome (Clarkson syndrome) in childhood: systematic literature review. Eur J Pediatr 2018; 177:1149-54. [PMID: 29936591 DOI: 10.1007/s00431-018-3189-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/31/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022]
Abstract
Approximately 500 cases of idiopathic systemic capillary leak syndrome (Clarkson syndrome) have been reported worldwide. This life-threatening condition is characterized by episodes of increase in vascular permeability with loss of fluid into the interstitium and presents with acute onset of edema, signs of tissue hypoperfusion, hemoconcentration, and low blood protein level. It has been diagnosed mainly in middle-aged adults with a monoclonal gammopathy. We performed a systematic review of the literature on Clarkson syndrome in subjects ≤ 18 years of age. We identified 24 reports, published since 1989, providing data on 32 otherwise healthy subjects, who experienced 67 well-documented episodes of Clarkson syndrome. The condition affected more frequently girls (21, 66%) than boys, presented throughout childhood, and was preceded by a mostly viral illness in 75% of cases. A monoclonal gammopathy was never reported. Uncompensated circulatory shock, muscle compartment syndrome, acute kidney injury, pulmonary edema, and either pleural or pericardial effusion were, in decreasing order of frequency, the most common complications. Four patients died.Conclusion: Clarkson syndrome develops not only in adulthood but also in childhood. In this age group, this condition is not linked to a monoclonal gammopathy. What is Known: • Clarkson syndrome is a rare condition that has been diagnosed mainly in middle-aged adults and is mostly linked to a monoclonal gammopathy. What is New: • In subjects ≤ 18 years of age, Clarkson syndrome is not linked to a monoclonal gammopathy.
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Raith EP, Ihle JF, Jamieson J, Kalff A, Bosco J. Idiopathic systemic capillary leak syndrome presenting as septic shock: A case report. Heart Lung 2018; 47:425-428. [PMID: 29779703 DOI: 10.1016/j.hrtlng.2018.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/18/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management. OBJECTIVE We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock. METHODS Structured case report and review of the literature. RESULTS A 27-year old man admitted to our institution with coryzal symptoms rapidly deteriorated with presumed sepsis, leading to intensive care unit admission. Following further deterioration, Idiopathic systemic capillary leak syndrome was considered and intravenous immunoglobulin administered, resulting in rapid improvement in the patient's clinical status. CONCLUSIONS Idiopathic systemic capillary leak syndrome is a rare and potentially life-threatening angiopathy that may present as, and should be considered in, refractory distributive shock. Administration of intravenous immunglobulin resulted in rapid recovery in this patient, and has been associated with positive outcomes in previous cases.
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Affiliation(s)
- Eamon P Raith
- Department of Intensive Care Medicine, The Royal Adelaide Hospital, Port Road, Adelaide, SA 5000, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Discipline of Acute Care Medicine, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
| | - Joshua F Ihle
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Jennifer Jamieson
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Anna Kalff
- Department of Clinical Haematology, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
| | - Julian Bosco
- Department of Allergy, Immunology, Respiratory Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia
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Hibi A, Mizuguchi K, Yoneyama A, Kasugai T, Kamiya K, Kamiya K, Ito C, Kominato S, Miura T, Koyama K. Severe refractory TAFRO syndrome requiring continuous renal replacement therapy complicated with Trichosporon asahii infection in the lungs and myocardial infarction: an autopsy case report and literature review. Ren Replace Ther 2018; 4:16. [PMID: 34171004 PMCID: PMC7149248 DOI: 10.1186/s41100-018-0157-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/22/2018] [Indexed: 01/09/2023] Open
Abstract
Background TAFRO (thrombocytopenia, anasarca, fever, reticulin myelofibrosis/renal failure, and organomegaly) syndrome is a systemic inflammatory disorder and unique clinicopathological variant of idiopathic multicentric Castleman disease that was proposed in Japan. Prompt diagnosis is critical because TAFRO syndrome is a progressive and life threating disease. Some cases are refractory to immunosuppressive treatments. Renal impairment is frequently observed in patients with TAFRO syndrome, and some severe cases require hemodialysis. Histological evaluation is important to understand the pathophysiology of TAFRO syndrome. However, systemic histopathological evaluation through autopsy in TAFRO syndrome has been rarely reported previously. Case presentation A 46-year-old Japanese man with chief complaints of fever and abdominal distension was diagnosed with TAFRO syndrome through imaging studies, laboratory findings, and pathological findings on cervical lymph node and bone marrow biopsies. Interleukin (IL)-6 and vascular endothelial growth factor (VEGF) levels were remarkably elevated in both blood and ascites. Methylprednisolone (mPSL) pulse therapy was initiated on day 10, followed by combination therapy with PSL and cyclosporine A. However, the amount of ascites did not respond to the treatment. The patient became anuric, and continuous renal replacement therapy was initiated from day 50. However, the patient suddenly experienced cardiac arrest associated with myocardial infarction (MI) on the same day. Although the emergent percutaneous coronary intervention was successfully performed, the patient died on day 52, despite intensive care. Autopsy was performed to ascertain the cause of MI and to identify the histopathological characteristics of TAFRO syndrome. Conclusions Bacterial peritonitis, systemic cytomegalovirus infection, and Trichosporon asahii infection in the lungs were observed on autopsy. In addition, sepsis-related myocardial calcification was suspected. Management of infectious diseases is critical to reduce mortality in patients with TAFRO syndrome. Although the exact cause of MI could not be identified on autopsy, we considered embolization by fungal hyphae as a possible cause. Endothelial injury possibly caused by excessive secretion of IL-6 and VEGF contributed to renal impairment. Fibrotic changes in anterior mediastinal fat tissue could be a characteristic pathological finding in patients with TAFRO syndrome.
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Affiliation(s)
- Arata Hibi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Ken Mizuguchi
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Akiko Yoneyama
- Deaprtment of Pathology, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Takahisa Kasugai
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Keisuke Kamiya
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195 Japan
| | - Chiharu Ito
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Satoru Kominato
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Toshiyuki Miura
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
| | - Katsushi Koyama
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Kariya Toyota General Hospital, 5-15, Sumiyoshi-cho, Kariya, Aichi 448-8505 Japan
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Fuentes Fernandez I, Hernandez-Clares R, Carreón Guarnizo E, Meca Lallana JE. Capillary leak syndrome in neuromyelitis optica treated with rituximab. Mult Scler Relat Disord 2017; 16:22-23. [PMID: 28755680 DOI: 10.1016/j.msard.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 06/05/2017] [Indexed: 11/17/2022]
Abstract
61-year-old woman with Neuromyelitis optica (NMO) diagnosis treated with rituximab was referred to our hospital with severe hypovolemic shock and anasarca. The laboratory findings showed marked hemoconcentration and a decrease in total serum protein. She developed a multiple organ failure and died three hours later. We diagnosed the patient as having capillary leak syndrome (CLS). CLS is a very rare condition caused by unexplained episodic capillary hyperpermeability, which can be idiopathic or secondary to some conditions like infection, malignant disease and some drugs like monoclonal antibodies. We reported the first CLS case in NMO patient treated with rituximab.
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Affiliation(s)
| | - Rocio Hernandez-Clares
- Multiple Sclerosis Unit, Neurology Department, Virgen de la Arrixaca Hospital, Murcia, Spain.
| | - Ester Carreón Guarnizo
- Multiple Sclerosis Unit, Neurology Department, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - Jose E Meca Lallana
- Multiple Sclerosis Unit, Neurology Department, Virgen de la Arrixaca Hospital, Murcia, Spain
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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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Abstract
Primary capillary leak syndrome is a rare disease of unknown etiology, characterized by episodes of vascular collapse and plasma extravasation, which may lead to multiple organ failure. Primary capillary leak is extremely rare in children. The authors report a case of a late preterm newborn with fatal capillary leak syndrome of unknown etiology, manifesting as hypotension unresponsive to treatment, extravasation leading to generalised edema, disseminated intravascular coagulation and finally, multiple organ dysfunction syndrome. Aggressive volumotherapy and a combination of inotropes and high doses of terlipressin did not influence systemic vascular collapse and plasma extravasation. The newborn developed multiple organ failure and died on day 27 of life. Investigations performed failed to reveal any specific cause of capillary leak. This is the first report of a fatal primary capillary leak syndrome in a newborn.
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Affiliation(s)
- Katarina Kulihova
- Department of Neonatology, Thomayer Hospital, Videnska 800, 14059, Prague, Praha 4, Czech Republic
| | - Martina Prochazkova
- Department of Neonatology, Thomayer Hospital, Videnska 800, 14059, Prague, Praha 4, Czech Republic
| | - Jana Semberova
- Department of Neonatology, Thomayer Hospital, Videnska 800, 14059, Prague, Praha 4, Czech Republic
| | - Jan Janota
- Department of Neonatology, Thomayer Hospital, Videnska 800, 14059, Prague, Praha 4, Czech Republic.
- Department of Pathophysiology, 1st Medical Faculty, Charles University in Prague, U Nemocnice 5, 12853, Prague, Praha 2, Czech Republic.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kang KW, Heo ST, Han SH, Park YG, Park HS. Systemic capillary leak syndrome induced by influenza type A infection. Clin Exp Emerg Med 2014; 1:126-129. [PMID: 27752564 PMCID: PMC5052828 DOI: 10.15441/ceem.14.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 01/05/2023] Open
Abstract
A 42-year-old man visited the emergency department complaining of lower extremity swelling and myalgia. His influenza A antigen test was positive, and he was admitted for supportive care of severe myalgia. On the first hospital day, the swelling in his lower legs was aggravated with intolerable pain, and his creatine phosphokinase and hemoglobin levels were elevated. He was treated with massive hydration, albumin replacement, continuous venovenous hemofiltration, phlebotomy, and oseltamivir. The swelling and pain in his extremities were decreased without renal dysfunction, even though peripheral neuropathy and muscular complication persisted. Systemic capillary leak syndrome is a rare but life-threatening condition. The diagnosis is made clinically based on a classic triad of hypotension, hypoalbuminemia, and hemoconcentration. In our case, the influenza A infection was related to the capillary leakage.
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Affiliation(s)
- Kyeong Won Kang
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Taek Heo
- Division of Infectious Diseases, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yong-Geun Park
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Hyun Soo Park
- Department of Emergency Medicine, Jeju National University School of Medicine, Jeju, Korea
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Kulkarni C, George TA, Av A, Ravindran R. Acute angle closure glaucoma with capilllary leak syndrome following snake bite. J Clin Diagn Res 2014; 8:VC01-VC03. [PMID: 25478432 DOI: 10.7860/jcdr/2014/10716.4924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Acute angle closure glaucoma is rarely seen as complication of snake bite.We report three cases of bilateral acute angle closure glaucoma with capillary leak syndrome and acute renal failure secondary to hematotoxic snake bites. We are also briefly discussing the association of capillary leak syndrome and angle closure glaucoma in hematotoxic snake bite. This is the first time an association between angle closure and capillary leak syndrome following snake bite is reported. STUDY TYPE Descriptive case series. MATERIALS AND METHODS Records of all patients admitted to ICU with snake bite were reviewed to identify cases developing acute angle closure glaucoma. These cases with acute angle closure glaucoma are analysed in detail for systemic condition. Diagnosis, management and outcome of cases are described Results: Of the 119 snake bites admitted, 47 patients had confirmed hematotoxic snake bite. Fifteen of these patients underwent hemodialysis for acute renal failure. Seven of them were diagnosed to have capillary leak syndrome and all of them complained of decreased vision. Three of the 7 cases had acute angle closure glaucoma on the second day of bite. One of the patients expired and other two recovered fully, both of them had normal IOP and good vision at one month follow-up. CONCLUSION Acute angle closure glaucoma seems to be associated with systemic capillary leak syndrome in hematotoxic snake bite. High suspicion, early recognition, timely and appropriate treatment can prevent visual loss in this rare complication.
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Affiliation(s)
| | - Twinkle Ann George
- Associate Professor, Department of Ophthalmology, Pariyaram Medical College , Pariyaram, Kerala, India
| | - Asha Av
- Professor, Department of Ophthalmology, Pariyaram Medical College , Pariyaram, Kerala, India
| | - Risha Ravindran
- Postgraduate Student, Department of Ophthalmology, Pariyaram Medical College , Pariyaram, Kerala, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ueda N, Chihara D, Kohno A, Tatekawa S, Ozeki K, Watamoto K, Morishita Y. Predictive value of circulating angiopoietin-2 for endothelial damage-related complications in allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:1335-40. [PMID: 24796281 DOI: 10.1016/j.bbmt.2014.04.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 04/28/2014] [Indexed: 12/18/2022]
Abstract
Endothelial cell damage has been reported to be associated with noninfectious transplant-related complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among these, noninfectious transplant-related complications with endothelial cell damage (TRC-EC) include sinusoidal occlusive syndrome, transplant-associated microangiopathy, intestinal transplant-associated microangiopathy, capillary leak syndrome, idiopathic pneumonia syndrome, and diffuse alveolar hemorrhage. Because angiopoietin-2 (ANG2) plays an essential role in the endothelial cell damage of various inflammatory disorders, we hypothesized that ANG2 may also play a critical role in TRC-EC. We retrospectively estimated the incidence of TRC-EC and evaluated the association with ANG2 level at transplant. We studied 153 consecutive adult patients who underwent allo-HSCT at our institution between 2000 and 2012. Median patient age was 49 years (range, 16 to 68 years). With a median follow-up of 55 months, 3-year overall survival for all patients was 55%. The incidence of TRC-EC at day 100 was significantly higher in the high-ANG2 group (≥2000 pg/mL; n = 36) than in the low-ANG2 group (<2000 pg/mL; n = 117) (70% [95% confidence interval {CI}, 55% to 84%] versus 16% [95% CI, 11% to 24%]; P < .001). Multivariate analysis revealed that high ANG2 level at transplant was independently associated with higher risk of TRC-EC (hazard ratio, 6.01; 95% CI, 3.16 to 11.43; P < .001) and shorter overall survival (hazard ratio, 2.23; 95% CI, 1.66 to 4.48; P = .002). These results suggest that ANG2 level at transplant may be a useful marker for predicting the risk of TRC-EC after allo-HSCT. Prospective studies are warranted to validate our results.
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Affiliation(s)
- Norihiro Ueda
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan; Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Dai Chihara
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Akio Kohno
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
| | - Shotaro Tatekawa
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
| | - Kazutaka Ozeki
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
| | - Koichi Watamoto
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
| | - Yoshihisa Morishita
- Division of Hematology and Oncology, JA Aichi Konan Kosei Hospital, Konan, Japan
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Abstract
Rhabdomyolysis (RML) after electrical burns and crush injuries is a well-known clinical entity, but its occurrence following thermal injury has not gained so much attention. Capillary leak syndrome and following polycompartmental syndrome are devastating end results of major thermal injuries. In the current review, polycompartment syndrome within the clinical picture of systemic oedema and its relationship to RML is discussed along with its management and prevention.
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