Capillary leak syndrome induced by neoadjuvant cisplatin and gemcitabine in a patient with bladder cancer

Abstract

Capillary leak syndrome (CLS) is a rare disorder associated with an increased capillar permeability due to an endothelial damage, causing leakage of plasma and proteins into the interstitial compartment. CLS is characterized by rapidly developing edema, hypotension and hypoproteinemia. We observed CLS in a 54-year-old man affected by muscle-invasive bladder cancer who received neoadjuvant treatment with CISPLATIN and GEMCITABINE. Treatment with infusion of albumin and increasing corticosteroid doses and diuretics led to a complete regression of all signs and symptoms related to the disorder. Of note, the patient showed an objective complete response to chemotherapy and underwent radical surgery on schedule.

Persistent Postoperative Vasoplegia After Ureteronephrectomy Due To Suspected Intravesical Gemcitabine Toxicity

“…3,4 Two other cases took 6 to 10 days to manifest, so the patients underwent exhaustive workups to arrive at gemcitabineinduced SCLS as a diagnosis of exclusion. 5,7 In all the cases, the symptoms resolved after treatment with intravascular volume repletion, corticosteroids, diuretics, and occasionally vasopressors. Some patients received additional cycles of gemcitabine therapy with prophylactic corticosteroids to prevent SCLS recurrence.…”

“…Gemcitabine toxicity was proposed as a diagnosis of exclusion given case reports of SCLS after intravenous (IV) administration. [3][4][5][6][7][8] The patient exhibited rapid-onset generalized edema, characteristic of SCLS due to extravasation of plasma into the interstitial space. Diagnosis of SCLS also requires hypotension, hemoconcentration, and hypoalbuminemia.…”

“…There are several case reports of gemcitabineinduced SCLS after intravenous chemotherapy regimens but, to our knowledge, none after intravesical treatment. [3][4][5][6][7][8] In reported cases, patients presented with AKI, hypoalbuminemia, anasarca, pulmonary edema, hypotension, and low-grade fever. 10 Symptom presentation occurred 2 to 3 days after intravenous gemcitabine administration.…”

Veno-venous-extracorporeal membrane oxygenation treatment for severe capillary leakage syndrome: A case report

“…CLS is a rare condition[ 6 , 7 ] associated with increased capillary permeability due to endothelial damage, resulting in leakage of plasma and protein into interstitial spaces[ 2 , 8 , 9 ]. It is characterized by rapidly developing edema, hypotension, and hypoproteinemia[ 10 , 11 ].…”

What Is Happening to This Patient With a Rare Leukemia?

“…Capillary leak syndrome can be idiopathic (also called Clarkson's disease) or secondary to certain autoimmune diseases, infections (sepsis), snakebites, cancers, and drugs ( Aneja, 2021 ; Fuentes Fernandez et al, 2017 ; Jeong et al, 2019 ; Massafra et al, 2021 ; Qin et al, 2021 ; Siddall et al, 2017 ). The following has been observed in cases of CLS: increased levels of monoclonal proteins, anti-inflammatory mediators, interleukin-2, and vascular endothelial growth factor, as well as endothelial cell apoptosis ( Aneja, 2021 ).…”