Capillary leak syndrome

Capillary Leak Syndrome

Capillary Leak Syndrome (CLS), also known as systemic capillary leak syndrome or Clarkson's disease, is a rare medical condition characterized by episodes of severe hypotension, hypoalbuminemia, and hemoconcentration due to the leakage of plasma from the capillaries into the surrounding tissues. This condition can lead to life-threatening complications if not promptly recognized and treated.

Pathophysiology

The underlying mechanism of capillary leak syndrome involves a transient dysfunction of the endothelial cells lining the capillaries. This dysfunction results in increased vascular permeability, allowing plasma to escape into the interstitial space. The exact cause of this endothelial dysfunction is not fully understood, but it is believed to involve inflammatory mediators and cytokines.

Clinical Presentation

Patients with capillary leak syndrome typically present with sudden onset of:

• Hypotension: Due to the loss of intravascular volume.
• Edema: Particularly in the extremities, face, and trunk.
• Hemoconcentration: Elevated hematocrit levels due to plasma leakage.
• Hypoalbuminemia: Low serum albumin levels as albumin leaks out of the vascular compartment.

Diagnosis

The diagnosis of capillary leak syndrome is primarily clinical, supported by laboratory findings of hemoconcentration and hypoalbuminemia. Imaging studies may show fluid accumulation in tissues, but these are not specific to CLS. It is important to rule out other causes of similar symptoms, such as sepsis or anaphylaxis.

Management

Management of capillary leak syndrome involves supportive care and addressing the underlying cause if identified. Treatment strategies include:

• Fluid Resuscitation: To maintain blood pressure and organ perfusion.
• Albumin Replacement: To restore oncotic pressure and reduce edema.
• Vasopressors: In cases of severe hypotension.
• Preventive Measures: In chronic cases, medications such as theophylline and terbutaline have been used to prevent episodes.

Prognosis

The prognosis of capillary leak syndrome varies depending on the severity and frequency of episodes. Acute episodes can be life-threatening, but with appropriate management, patients can recover. Chronic cases may require long-term management strategies to prevent recurrent episodes.

Also see

• Endothelial dysfunction
• Hypotension
• Edema
• Hypoalbuminemia
• Systemic inflammatory response syndrome