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Narrative review: the systemic capillary leak syndrome.
[systemic capillary leak syndrome]
The
systemic
capillary
leak
syndrome
(
SCLS
)
is
a
rare
disease
of
reversible
plasma
extravasation
and
vascular
collapse
accompanied
by
hemoconcentration
and
hypoalbuminemia
.
Its
cause
is
unknown
,
although
it
is
believed
to
be
a
manifestation
of
transient
endothelial
dysfunction
due
to
endothelial
contraction
,
apoptosis
,
injury
,
or
a
combination
of
these
.
Fewer
than
150
cases
of
SCLS
have
been
reported
,
but
the
condition
is
probably
underrecognized
because
of
its
nonspecific
symptoms
and
signs
and
high
mortality
rate
.
Patients
experience
shock
and
massive
edema
,
often
after
a
nonspecific
prodrome
of
weakness
,
fatigue
,
and
myalgias
,
and
are
at
risk
for
ischemia-induced
organ
failure
,
rhabdomyolysis
and
muscle
compartment
syndromes
,
and
venous
thromboembolism
.
Shock
and
edema
reverse
almost
as
quickly
as
they
begin
,
at
which
time
patients
are
at
risk
for
death
from
flash
pulmonary
edema
during
rapid
fluid
remobilization
.
Diagnosis
is
made
clinically
and
by
exclusion
of
other
diseases
that
cause
similar
symptoms
and
signs
,
most
notably
sepsis
,
anaphylaxis
,
and
angioedema
.
Acute
episodes
are
treated
with
vasopressor
therapy
and
judicious
fluid
replacement
,
possibly
with
colloid
solutions
for
their
osmotic
effects
,
to
prevent
the
sequelae
of
underperfusion
.
Between
episodes
,
patients
may
be
treated
with
theophylline
and
terbutaline
,
which
clinical
experience
suggests
may
reduce
the
severity
and
frequency
of
acute
episodes
.
Prognosis
is
uncertain
,
but
patients
who
survive
an
initial
severe
SCLS
episode
are
estimated
to
have
a
10
-
year
survival
rate
greater
than
70
%
.
Much
remains
to
be
learned
about
SCLS
,
and
clinicians
should
consider
the
diagnosis
in
patients
with
unexplained
edema
,
increased
hematocrit
,
and
hypotension
.
Diseases
Validation
Diseases presenting
"often after a nonspecific prodrome of weakness"
symptom
systemic capillary leak syndrome
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