Capillary leak syndrome with tamponade

• Published in: Anaesthesia and intensive care Vol. 47; no. 3; pp. 305 - 306
• Main Authors: Moynihan, Gerard V, Teo, Patrick CK, Lee, Frederick J, Zoeller, Matt R
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2019; Sage Publications Ltd
• Subjects: Authorship; Cardiovascular disease; Edema; Kinases; Germany
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X19845380

A creatine kinase level of 60,000 units (U)/L (reference range 0–250 U/L) was attributed to severe muscle oedema and a resultant widespread compartment syndrome. Cases associated with both autoimmune diseases and drugs such as oxaliplatin have been described.2 The median age of patients diagnosed with CLS in one series was 55 years.1 CLS presents as recurrent episodes of shock and anasarca. The syndrome is characterised by three different stages; a flu-like prodrome, transient leakage of fluid and proteins at a capillary level, and finally resolution.1 The second stage is characterised by hypotension and oedema, and can mimic septic shock.3 Angioedema and anaphylaxis, which have plasma leakage as part of their pathophysiology, should also be considered in the differential diagnosis.4 Although CLS is a clinical diagnosis, a paraprotein may be present between attacks.1 Initial investigations will reveal intravascular hypovolaemia, haemoconcentration and hypoalbuminaemia.4,5 Proteinuria is absent.1 Fluid can accumulate in any organ or potential space, causing a range of complications: respiratory failure (from pulmonary oedema or pleural effusions), shock (from hypovolaemia or cardiac tamponade), mesenteric ischaemia (from severe oedema of the gut and hepatic congestion) and, as in this case, compartment syndrome and rhabdomyolysis (from muscle oedema).1 In the acute phase, IVIg is recommended to decrease mortality.6 The use of plasmapheresis has been described.1 Judicious fluid therapy in the early resuscitation period is important.