SHM Converge Scientific Abstract ePoster Gallery-Capillary Leak Syndrome Manifesting With Lumbar Pain and Renal Injury

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This case report describes a 66-year-old woman who presented with 2 weeks of severe lumbar back pain and was later found to have systemic capillary leak syndrome (SCLS), also known as Clarkson’s disease. SCLS is a very rare disorder, with fewer than 300 cases reported worldwide, caused by abnormal vascular permeability leading to leakage of fluid and proteins into the interstitial space. Its classic triad is hypotension, hemoconcentration, and hypoalbuminemia.<br /><br />The patient initially had back pain radiating to both thighs and only mild hypotension and tachycardia. Imaging showed degenerative lumbar spine disease, but her course rapidly worsened. By hospital day 2, she developed acute kidney injury that progressed despite aggressive hydration and albumin replacement. She later developed severe abdominal pain, worsening hypoalbuminemia, oliguria, generalized edema, metabolic acidosis, and fulminant liver failure. Blood and urine cultures were negative, helping exclude sepsis. She was also treated for possible adrenal insufficiency. As her condition deteriorated, she developed altered mental status and shortness of breath, requiring intubation. Despite multiple vasopressors, she progressed to hypoxic respiratory failure, refractory shock, multiorgan failure, and died 10 days after admission.<br /><br />The authors emphasize that diagnosis of SCLS is often delayed because it is rare and can mimic sepsis, anaphylaxis, or medication reactions. This case was unusual because the presenting symptom was severe lumbar pain, which had not previously been reported as a prodromal symptom of SCLS. The report highlights the importance of recognizing the triad of hypotension, hemoconcentration, and hypoalbuminemia early, as delayed diagnosis is associated with poor outcomes and high mortality.

Asset Subtitle

Tina J. Kana

Meta Tag

Author List Ahmed Kawamj, Tina J. Kana, Vamsee Reddy, Zainab Shamim

Category Clinical Vignettes

Concept Systemic Capillary Leak Syndrome

Concept Hypotension

Concept Hemoconcentration

Concept Hypoalbuminemia

Concept Multiorgan failure

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Tina J. Kana

Track Adult

Keywords

systemic capillary leak syndrome

Clarkson disease

hypotension

hemoconcentration

hypoalbuminemia

lumbar back pain

acute kidney injury

multiorgan failure

vascular permeability

septic shock mimic

Systemic Capillary Leak Syndrome

Hypotension

Hemoconcentration

Hypoalbuminemia

Multiorgan failure