Systemic capillary leak syndrome complicated by lower extremity compartment syndrome: a case report

TL;DR

A 29-year-old man with systemic capillary leak syndrome developed a rare complication of bilateral lower extremity compartment syndrome, requiring surgical intervention.

Contribution

This case report highlights the previously under-recognized risk of compartment syndrome in patients with systemic capillary leak syndrome.

Findings

A patient with SCLS developed bilateral lower-limb compartment syndrome requiring fasciotomy.

The patient showed sensory deficits and impaired ankle movement but recovered enough to ambulate with a cane.

The case underscores the importance of monitoring for musculoskeletal complications in SCLS patients.

Abstract

Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by hypotension, hypoalbuminemia, and hemoconcentration, typically caused by increased vascular permeability due to endothelial dysfunction. We report a case of SCLS complicated by bilateral lower extremity compartment syndrome.

A 29-year-old man developed fever, cough, and rhinorrhea. He was restless, hypotensive, and had generalized edema with tense extremities. Laboratory findings included a hemoglobin level of 24.9 g/dL, hematocrit of 69.3%, albumin of 1.8 g/dL, and creatinine of 3.27 mg/dL. SCLS-induced shock was diagnosed with detection of monoclonal gammopathy of the IgG-λ type. Treatment consisted of fluid resuscitation, vasopressors, high-dose corticosteroids, and intravenous immunoglobulin. Although hemodynamic status improved, he developed bilateral lower-limb compartment syndrome, necessitating fasciotomy. Although the patient exhibited sensory deficits and impaired dorsiflexion and plantarflexion in both ankles, he was able to ambulate with a cane and was discharged on hospital day 50.

This case highlights the risk of serious complications such as compartment syndrome in patients with SCLS.

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