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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
"fatigue"
symptom
benign recurrent intrahepatic cholestasis
cholangiocarcinoma
congenital adrenal hyperplasia
cowden syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dracunculiasis
erdheim-chester disease
esophageal carcinoma
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kabuki syndrome
lymphangioleiomyomatosis
neuralgic amyotrophy
pleomorphic liposarcoma
systemic capillary leak syndrome
triple a syndrome
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
x-linked adrenoleukodystrophy
This symptom has already been validated