Hasan KARSEN, Emine Ayça GÜLER, Füruzan KAYA, İrfan BİNİCİ, Mehmet Reşat CEYLAN

Kapiller Kaçış Sendromu: Klinik Tecrübemiz ve Literatür İncelenmesi

Amaç: Amacımız, potansiyel olarak fatal ve oldukça nadir görülen Capillaryleaksyndrome (CLS) tanısı koyduğumuz hastaları literatür eşliğinde tartışarak klinisyenlerin dikkatine sunmaktır. Materyal ve Metod: Çalışmaya 2010-2016 yılları arasında CLS tanısı alan6 vaka alındı. Hastaların tanısı, hipotansiyon (sistolik kan basıncı ≤90 mmHg veya mevcut kan basıncının ≥40 mmHg düşmesi), hemokonsantrasyon, hipoalbuminemi (albumin düzeyinin ≥0.5 gr /dL düşmesi) ve ödem (lokal veya anazarka tarzında) klinik bulgularıyla konuldu. Hastaların bilgileri, retrospektif hasta dosyaları incelenerek elde edildi. Bu çalışma,üniversitemiz enfeksiyon hastalıkları kliniği ve yoğun bakım ünitesinde yapıldı. Bulgular: Hastaların üçü erkek, üçü kadın olup yaşları 22-80 arasındaydı. Hastalardan biri bruselloz, biri tüberküloz, biri derin ventrombozu ve pulmoneremboli nedeniyle yoğun bakıma alınan, biri hipoglisemik koma nedeniyle yoğun bakımda takip edilen, biri akut myeloid lösemi (AML) nedeniyle kemoterapi alan diğeri büyük cerrahi girişim uygulanan hastalardan oluşuyordu. AML hastası hariç diğer hastalarda birden fazla bakteri superpoze olarak hastaların sepsise girmelerine neden oldu. Hastaların tümü entübe edildiğinden kan kültürü yanı sıra alınan derin trakealaspiratta da üreme oldu. Bu enfeksiyonlar, hem CLS gelişmesine hem de mortaliteyle sonuçlanmasına neden oldu. Takip ve tedavi sonunda bütün çabamıza rağmen hastalarımızın tamamı exitus oldu. Sonuç: CLS oldukça nadir, mortalitesi hala yüksek, tedavisi hala belirsiz gizemli bir hastalık olarak kalmaya devam etmektedir. Klinisyenlerin özellikle septik durumlarda hastaların CLS’ye gidişi konusunda uyanık olmaları gerekir. Zira erken tanı ve tedavi döngüyü hastanın lehine çevirecekbilecektir

Anahtar Kelimeler:

Kapiller kaçış sendromu, klinik tecrübe, tanı, tedavi, prognoz

Capillary Leak Syndrome: Our Clinical Experience and Literature Review

Background: Our objective is to discuss the cases of patients diagnosed with capillary leak syndrome (CLS) that is a potentially fatal and extremely rare condition, in the light of literature, and present them to clinicians’ attention. Material and Method: Six cases diagnosed with CLS between 2010 and 2016 were included in the study. The patients were diagnosed with clinical findings including hypotension (systolic blood pressure ≤90 mmHg, or a decline of ≥40 mmHg in immediate blood pressure), hemoconcentration, hypoalbuminemia (a decrease of ≥0.5 gr /dL in albumin level) and edema (local or anasarca). Information about the patients was elicited through the analysis of patient files retrospectively. The present study was carried out at the Infectious Diseases Clinic and Intensive Care Unit of Harran University Hospital. Results: Of the six patients, three were males and three were females, and their ages ranged between 22-80. The patients’ diagnoses were one patient brucellosis and one patient tuberculosis, one patient monitored in intensive care unit because of deep vein thrombosis along with pulmonary embolism and the other monitored due to hypoglycemic coma, one patient who received chemotherapy due to acute myeloid leukemia (AML), and the other one who have undergone a critical surgical intervention. Except for the patient with AML, multiple bacterial species became superposed in the patients and caused them to progress into sepsis. As all patients were intubated, culture growth was detected in deep tracheal aspirates apart from blood culture. These infections gave rise to both the development of CLS and increased mortality. All of the patients died, despite our all efforts of treatment and follow-up interventions Conclusion: CLS remains to be a mysterious illness which is extremely rare. It still has high mortality and does not have a certain treatment. Clinician needs to be alert about the patients’ progress to CLS, partic

Keywords:

Capillary leak syndrome, clinical experience, diagnosis, treatment, prognosis,

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