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Minerva Anestesiologica 2002 December;68(12):929-36

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English, Italian

Systemic capillary leak syndrome. Case report

Sabbadini D. D. 1, Peressutti R. 1, Di Silvestre A. 1, Lucchese F. 1, Margarit O. 1, Macor D. 1, Petrei D. 1, Salino R. 1, Rossi P. 2, Schiavon I. 2, Giordano F. 1

1 Second Division of Anesthesia Resuscitation and Antalgic Therapy 2 Third Division of General Medicine Santa Maria della Misericordia Hospital Udine


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We ­here ­report the ­case of a ­patient ­with system­ic cap­il­lary ­leak syn­drome (­SCLS). ­This syn­drome is a ­rare con­di­tion char­ac­ter­ized by recur­rent epi­sodes of hypo­ten­sion ­with hemo­con­cen­tra­tion and hypo­pro­tei­ne­mia. It is due to unex­plained epi­sod­ic cap­il­lary hyper­per­mea­bil­ty ­that ­results in ­fluid and pro­tein ­shift ­from the intra­vas­cu­lar to the inter­sti­tial ­space: gen­er­al­ized ede­ma, ­shock and ­renal fail­ure fol­low. A 59 yo man was admit­ted to our inten­sive ­care ­unit ­because of unex­plained ­shock ­with hemo­con­cen­tra­tion, ­renal fail­ure, and meta­bol­ic aci­do­sis. Pre­vi­ous ­attemps to ­reverse ­shock in a med­i­cal ­ward ­with crys­tal­loids and dop­a­mine ­failed. An abdom­i­nal CT ­scan, a TEE, and ­chest X ray ­study ­were incon­clu­sive. No ­sign or his­to­ry of ­major infec­tions or anaph­y­lax­is ­were ­present. The ­patient was resus­ci­tat­ed ­with mas­sive ­fluid infu­sions and nor­epi­neph­rine on the ­guide of a ­Swan ­Ganz cath­e­ter. The diag­no­sis was ­made on the ­basis of a pre­vi­ous epi­sode of ­severe ­shock com­pli­cat­ed ­with ­renal fail­ure and a com­part­ment syn­drome, the hemo­con­cen­tra­tion, and the neg­a­tive car­di­o­pul­mo­nary find­ings. A ­small ­amount of mono­clo­nal immu­no­glob­u­lin G, kap­pa ­chain, ­found in the ser­um con­firmed the diag­no­sis. The ­SCLS ­should be con­sid­ered in the dif­fe­ren­tial diag­no­sis of idiopath­ic and anaph­y­lac­tic ­shock. ­Patients may bene­fit from a pro­phy­lac­tic treat­ment ­with theo­phil­line and ter­bu­ta­line.

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