PDF(Pubmed)
Abstract：
Capillary leak syndrome (CLS) is a serious disorder characterized by hypotension and refractory systemic oedema. CLS with marked ascites rather than systemic oedema is rare and prone to misdiagnosis and delayed treatment. We report here a case of marked ascites in an elderly male patient with hepatitis B virus reactivation. Following investigations to exclude common diseases that may have accounted for diffuse oedema and hypercoagulable state, anti-cirrhosis therapy failed and severe refractory shock developed 48 hours after admission. The patient developed mild pleural effusions followed by swelling of the face, neck, and extremities. A high cytokine concentration gradient was detected between serum and ascites. Peritoneal biopsy showed lymphoma cells. The final diagnosis was lymphoma recurrence complicated with CLS. Our case suggests that cytokine detection in serum and ascitic fluid may be helpful in the differential diagnosis of CLS. In similar cases, decisive intervention, such as, hemodiafiltration, should be implemented to lessen the likelihood of serious complications.
摘要：
毛细血管渗漏综合征（CLS）是一种严重的疾病，其特征是低血压和难治性全身性水肿。具有明显腹水而不是全身性水肿的CLS很少见，容易误诊和延迟治疗。我们在这里报告了一例患有乙型肝炎病毒再激活的老年男性患者的明显腹水。在排除可能导致弥漫性水肿和高凝状态的常见疾病后，抗肝硬化治疗失败,入院后48小时出现严重难治性休克.患者出现轻度胸腔积液，随后面部肿胀，脖子,和四肢。在血清和腹水之间检测到高细胞因子浓度梯度。腹膜活检示淋巴瘤细胞。最终诊断为淋巴瘤复发合并CLS。我们的病例表明，血清和腹水中的细胞因子检测可能有助于CLS的鉴别诊断。在类似情况下,果断干预,例如,血液透析滤过,应实施以减少严重并发症的可能性。
