Capillary leak syndrome overview: Difference between revisions
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==Historical Perspective== | ==Historical Perspective== | ||
The [[syndrome]] was first described by B. Clarkson in 1960, after whom it was later informally named. Beyond numerous case reports published since then, two comprehensive reviews of clinical and research experience were published in 2010. | The [[syndrome]] was first described by B. Clarkson in 1960, after whom it was later informally named. Beyond numerous case reports published since then, two comprehensive reviews of clinical and research experience were published in 2010. | ||
==[[Capillary leak syndrome pathophysiology|Pathophysiology]]== | |||
The pathogenesis of capillary leak syndrome remain unclear, however, '''[https://www.wikidoc.org/index.php/Cytokines cytokines]''', '''[https://www.wikidoc.org/index.php/Vascular_endothelial_growth_factor vascular endothelial growth factor]''' (VEGF), '''[https://www.wikidoc.org/index.php/Leukotrienes leukotrienes]''', and '''complement''' play an important role. During each episode of hyperpermeability of the vasculature, there is an increase of interleukin 2 receptor-positive peripheral blood M-cell count, as well as apoptosis of the endothelial cells. | |||
== Causes == | ==Causes== | ||
Capillary leak syndrome may be a result of various diseases, and an adverse effect of numerous drugs. | Capillary leak syndrome may be a result of various diseases, and an adverse effect of numerous drugs. | ||
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Drugs associated with capillary leak syndrome include [https://www.wikidoc.org/index.php/Acitretin Acitretin], [https://www.wikidoc.org/index.php/Aldesleukin Aldesleukin], [https://www.wikidoc.org/index.php/Denileukin_diftitox Denileukin diftitox], [https://www.wikidoc.org/index.php/Filgastrim Filgastrim], [https://www.wikidoc.org/index.php/Oprelvekin Oprelvekin], [https://www.wikidoc.org/index.php/Sargramostim Sargramostim], [https://www.wikidoc.org/index.php/Tbo-filgrastim tbo-filgrastim,] gemcitabine, and monoclonal antibodies. | Drugs associated with capillary leak syndrome include [https://www.wikidoc.org/index.php/Acitretin Acitretin], [https://www.wikidoc.org/index.php/Aldesleukin Aldesleukin], [https://www.wikidoc.org/index.php/Denileukin_diftitox Denileukin diftitox], [https://www.wikidoc.org/index.php/Filgastrim Filgastrim], [https://www.wikidoc.org/index.php/Oprelvekin Oprelvekin], [https://www.wikidoc.org/index.php/Sargramostim Sargramostim], [https://www.wikidoc.org/index.php/Tbo-filgrastim tbo-filgrastim,] gemcitabine, and monoclonal antibodies. | ||
==[[Capillary leak syndrome differential diagnosis|Differentiating Capillary leak syndrome from other Diseases]]== | ==[[Capillary leak syndrome differential diagnosis|Differentiating Capillary leak syndrome from other Diseases]]== | ||
As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include [https://www.wikidoc.org/index.php/Adrenal_insufficiency Adrenal insufficiency], [https://www.wikidoc.org/index.php/Anaphylaxis Anaphylaxis], [https://www.wikidoc.org/index.php/Carcinoid_syndrome Carcinoid Syndrome], [https://www.wikidoc.org/index.php/Chronic_heart_failure Chronic Heart Failure], [https://www.wikidoc.org/index.php/Enteropathy Enteropathy], [https://www.wikidoc.org/index.php/Gleich_syndrome Gleich syndrome], [https://www.wikidoc.org/index.php/Hereditary_angioedema Hereditary angioedema], [https://www.wikidoc.org/index.php/Inferior_vena_cava_syndrome Inferior vena cava syndrome], [https://www.wikidoc.org/index.php/Mastocytosis Mastocytosis], [https://www.wikidoc.org/index.php/Nephrotic_syndrome Nephrotic syndrome], [https://www.wikidoc.org/index.php/Ovarian_hyperstimulation_syndrome Ovarian hyperstimulation syndrome], [https://www.wikidoc.org/index.php/Pancreatitis Pancreatitis], [https://www.wikidoc.org/index.php/Pheochromocytoma Pheochromocytoma], [https://www.wikidoc.org/index.php/Primary_amyloidosis Primary amyloidosis], [https://www.wikidoc.org/index.php/Sepsis Sepsis] and [https://www.wikidoc.org/index.php/Toxic_shock_syndrome Toxic shock syndrome]. Some other conditions that should be considered as a differential diagnosis include [https://www.wikidoc.org/index.php/Differentiation_syndrome Differentiation syndrome], [https://www.wikidoc.org/index.php/Engraftment_syndrome Engraftment syndrome], [https://www.wikidoc.org/index.php/Hemophagocytic_lymphohistiocytosis Hemophagocytic lymphohistiocytosis], [https://www.wikidoc.org/index.php/Viral_hemorrhagic_fevers Viral hemorrhagic fevers], [https://www.wikidoc.org/index.php/Snakebites Snakebite] envenomation, [https://www.wikidoc.org/index.php/Ricin Ricin] poisoning, as well as multiple [https://www.wikidoc.org/index.php/Autoimmune_conditions autoimmune conditions]. | As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include [https://www.wikidoc.org/index.php/Adrenal_insufficiency Adrenal insufficiency], [https://www.wikidoc.org/index.php/Anaphylaxis Anaphylaxis], [https://www.wikidoc.org/index.php/Carcinoid_syndrome Carcinoid Syndrome], [https://www.wikidoc.org/index.php/Chronic_heart_failure Chronic Heart Failure], [https://www.wikidoc.org/index.php/Enteropathy Enteropathy], [https://www.wikidoc.org/index.php/Gleich_syndrome Gleich syndrome], [https://www.wikidoc.org/index.php/Hereditary_angioedema Hereditary angioedema], [https://www.wikidoc.org/index.php/Inferior_vena_cava_syndrome Inferior vena cava syndrome], [https://www.wikidoc.org/index.php/Mastocytosis Mastocytosis], [https://www.wikidoc.org/index.php/Nephrotic_syndrome Nephrotic syndrome], [https://www.wikidoc.org/index.php/Ovarian_hyperstimulation_syndrome Ovarian hyperstimulation syndrome], [https://www.wikidoc.org/index.php/Pancreatitis Pancreatitis], [https://www.wikidoc.org/index.php/Pheochromocytoma Pheochromocytoma], [https://www.wikidoc.org/index.php/Primary_amyloidosis Primary amyloidosis], [https://www.wikidoc.org/index.php/Sepsis Sepsis] and [https://www.wikidoc.org/index.php/Toxic_shock_syndrome Toxic shock syndrome]. Some other conditions that should be considered as a differential diagnosis include [https://www.wikidoc.org/index.php/Differentiation_syndrome Differentiation syndrome], [https://www.wikidoc.org/index.php/Engraftment_syndrome Engraftment syndrome], [https://www.wikidoc.org/index.php/Hemophagocytic_lymphohistiocytosis Hemophagocytic lymphohistiocytosis], [https://www.wikidoc.org/index.php/Viral_hemorrhagic_fevers Viral hemorrhagic fevers], [https://www.wikidoc.org/index.php/Snakebites Snakebite] envenomation, [https://www.wikidoc.org/index.php/Ricin Ricin] poisoning, as well as multiple [https://www.wikidoc.org/index.php/Autoimmune_conditions autoimmune conditions]. | ||
Revision as of 23:40, 7 August 2022
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Capillary leak syndrome Microchapters |
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Case Studies |
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Capillary leak syndrome overview On the Web |
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American Roentgen Ray Society Images of Capillary leak syndrome overview |
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Risk calculators and risk factors for Capillary leak syndrome overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: M. Hassan, M.B.B.S
Overview
Capillary leak syndrome is a rare medical condition characterized by self-reversing episodes during which the endothelial cells which line the capillaries are thought to separate for a few days, allowing for a leakage of fluid from the circulatory system to the interstitial space, resulting in a dangerous hypotension, hemoconcentration, and hypoalbuminemia. It is a life-threatening illness because each episode has the potential to cause damage to, or the failure of, vital organs due to limited perfusion. It is often misdiagnosed as polycythemia, polycythemia vera or sepsis.
Historical Perspective
The syndrome was first described by B. Clarkson in 1960, after whom it was later informally named. Beyond numerous case reports published since then, two comprehensive reviews of clinical and research experience were published in 2010.
Pathophysiology
The pathogenesis of capillary leak syndrome remain unclear, however, cytokines, vascular endothelial growth factor (VEGF), leukotrienes, and complement play an important role. During each episode of hyperpermeability of the vasculature, there is an increase of interleukin 2 receptor-positive peripheral blood M-cell count, as well as apoptosis of the endothelial cells.
Causes
Capillary leak syndrome may be a result of various diseases, and an adverse effect of numerous drugs.
Conditions associated with capillary leak syndrome include sepsis, engraftment syndrome, differentiation syndrome, ovarian hyperstimulation syndrome, hemophagocytic lymphohistiocytosis, viral hemorrhagic fevers, autoimmune disease, snakebite envenomation, and ricin poisoning.
Drugs associated with capillary leak syndrome include Acitretin, Aldesleukin, Denileukin diftitox, Filgastrim, Oprelvekin, Sargramostim, tbo-filgrastim, gemcitabine, and monoclonal antibodies.
Differentiating Capillary leak syndrome from other Diseases
As capillary leak syndrome has overlapping clinical and laboratory findings with various other conditions, it should be considered as the diagnosis of exclusion. Some common ones include Adrenal insufficiency, Anaphylaxis, Carcinoid Syndrome, Chronic Heart Failure, Enteropathy, Gleich syndrome, Hereditary angioedema, Inferior vena cava syndrome, Mastocytosis, Nephrotic syndrome, Ovarian hyperstimulation syndrome, Pancreatitis, Pheochromocytoma, Primary amyloidosis, Sepsis and Toxic shock syndrome. Some other conditions that should be considered as a differential diagnosis include Differentiation syndrome, Engraftment syndrome, Hemophagocytic lymphohistiocytosis, Viral hemorrhagic fevers, Snakebite envenomation, Ricin poisoning, as well as multiple autoimmune conditions.
Epidemiology and Demographics
Between 1960 to 2006, hundred cases of systemic capillary leak syndrome were reported in the world literature.
Capillary leak syndrome has been described in children, however, it is sporadic and is diagnosed most often in previously healthy, middle-aged, Caucasian adults (median age ± S.D.: 45 ± 15 yrs; age range 5 months to 74 years).
Based of 107 cases of capillary leak syndrome where information was available, 57% of the individuals were male.
Risk Factors
Independent risk factors for capillary leak syndrome in neonates include respiratory distress syndrome, sepsis, cold injury syndrome, and hyperglycemia. Condition with monoclonal or M protein detected in the blood as well as autoimmune diseases are risk factors for the development of capillary leak syndrome. Because of the rarity of the disease there are pending investigations pertaining to the underlying cause.
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies