Internal and Emergency Medicine

, Volume 14, Issue 5, pp 723–730 | Cite as

Handling shock in idiopathic systemic capillary leak syndrome (Clarkson’s disease): less is more

  • Maddalena Alessandra WuEmail author
  • Riccardo Colombo
  • Gian Marco Podda
  • Marco Cicardi
Im-Point of View


Idiopathic systemic capillary leak syndrome (ISCLS) presents with recurrent potentially life-threatening episodes of hypovolemic shock associated with severe hemoconcentration and hypoproteinemia. Timely recognition is of paramount importance because ISCLS, despite resembling other kinds of hypovolemic shock, requires a peculiar approach, to prevent life-threatening iatrogenic damage. Due to the rarity of this condition with only scattered cases described worldwide, evidence-based recommendations are still lacking. Here, we summarize our 40 years’ experience in treating shock in ISCLS patients to derive a therapeutic algorithm. Records from 12 ISCLS patients (mean follow-up is 6 years, with a mean age at symptoms’ onset of 51.5 years) were informative for treatment modalities and outcome of 66 episodes of shock. Episodes are divided in three phases and treatment recommendations are the following: prodromal symptoms-signs (growing malaise, oligo-anuria, orthostatic dizziness) last 6–12 h and patients should maintain rigorous bed rest. The acute shock phase lasts 24–36 h. Patients should be admitted to ICU, placed on restrictive infusion of fluids favoring cautious boluses of high-molecular-weight plasma expanders when SAP < 70 mmHg; monitored for cerebral/cardiac perfusion, myocardial edema and signs of compartment syndrome. The post-acute (recovery) phase may last from 48 h to 1 week. Monitor for cardiac overload to prevent cardiac failure; in case of persistent renal failure, hemodialysis may be necessary; consider albumin infusion. Complications listed by frequency in our patients were acute renal failure, compartment syndrome and neuropathy, rhabdomyolysis, myocardial edema, pericardial–pleural–abdominal effusion, cerebral involvement, acute pulmonary edema and deep vein thrombosis.


Idiopathic systemic capillary leak syndrome Clarkson’s disease Shock Diagnosis Treatment 



We thank Dr. Andrea Zanichelli and Dr. Antonio Castelli, whose support was precious to deal with challenging clinical pictures. We express our gratitude to Dr. Chiara Suffritti for assistance with analyses of blood samples and to Dr. Guido Di Stefano for his helpful contribution for data collection. We wish to acknowledge the help received from Dr. Andrea Zancanaro, who provided data about a patient followed in his Center.

Compliance with ethical standards

Conflict of interest

No conflicts of interest to disclose.

Human and animal rights statement

Patients’ anonymity has been carefully protected.

Informed consent

All patients provided informed consent for the publication of anonymized data.

Supplementary material

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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Department of Biomedical and Clinical Sciences “Luigi Sacco”, ASST Fatebenefratelli Sacco, Luigi Sacco HospitalUniversity of MilanMilanItaly
  2. 2.Intensive Care UnitASST Fatebenefratelli SaccoMilanItaly
  3. 3.Medicina III, Dipartimento Di Scienze Della Salute, ASST Santi Paolo e CarloUniversity of MilanMilanItaly
  4. 4.IRCCS-Istituti Clinici Scientifici MaugeriUniversity of MilanMilanItaly

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