Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection

Abstract

Systemic capillary leak syndrome (SCLS), also known as Clarkson syndrome, is a rare disease with potential fatal outcome. The clinical picture involves leakage of fluid and protein from the bloodstream into peripheral tissues, resulting in hypoalbuminaemia, elevated haematocrit, oedema and hypotension. The spectrum of the symptoms ranges from discrete swelling/oedema of extremities to fulminant cardiogenic shock. We present a case with a 52-year-old man diagnosed with SCLS after being resuscitated from cardiac arrest, which was complicated by compartment syndrome. The severe episode of capillary leak was potentially triggered by influenza virus infection. With the benefit of hindsight, he presented with symptoms of SCLS 2 years prior the major acute episode. Here we describe this case and review some aspects of the literature on SCLS, with particular focus on the pathogenesis, treatment/prophylaxis and long-term physical and psychological complications.

Nivolumab-Induced Systemic Capillary Leak Syndrome as an Ultra Rare Life-Threatening Phenomenon of Late Toxicity and Intravenous Immunoglobulin Efficacy

“…However, monoclonal gammopathy is seen in 75% of patients with idiopathic SCLS and although not required for the diagnosis, it leads us to believe that our patients symptoms are due to another etiology [11]. Additionally, many patients describe a flu-like prodrome in idiopathic SCLS, one that was not present in our patient and lead us to further rule out idiopathic SCLS to be the cause [14].…”

Hypoalbuminemia as Surrogate and Culprit of Infections

“…Patients with colorectal cancer who develop infectious complications after laparoscopic surgery have more pronounced postoperative hypoalbuminemia on days 2 and 3 than patients with uncomplicated surgery [ 106 ], suggesting that measurement of serum albumin levels may be helpful in the early recognition of postoperative infection. Hypoalbuminemia is associated with the severity of different kinds of infections, including those caused by Pseudomonas aeruginosa , Clostridium difficile , and influenza [ 101 , 107 , 108 ], and albumin levels are predictive of infection complications as shown in scrub typhus [ 109 ].…”

An enlightening role for cytokine storm in coronavirus infection

“…Studies on cytokine responses in extra-respiratory organs or tissues during coronavirus infection are insufficient, but in the field of influenza virus, systemic cytokine responses have been demonstrated to increase the severity of influenza [ 71 , 72 , 83 ]. Severe influenza virus infections are associated with central nervous system (CNS) and cardiovascular disease [ 84 , 85 ]. The associated clinical manifestations with cytokine storm are shown in Fig.…”