Control of systemic capillary leak syndrome with aminophylline and terbutaline.
OBJECTIVE
Patients with systemic capillary leak syndrome have a characteristic triad of hypotension, hemoconcentration, and monoclonal gammopathy. They have frequent and severe attacks of hemoconcentration and hypotension accompanied by marked plasma shifts. The exact role of this monoclonal protein is unknown, but it probably leads, in some way, to an increase in capillary permeability. Despite efforts to resuscitate the patients during an acute attack, the syndrome is often fatal. Some success has been obtained in preventing the attacks with the beta-adrenergic-stimulating agent terbutaline. The purpose of this study was to determine the effectiveness of aminophylline and terbutaline in the treatment of systemic capillary leak syndrome.


METHODS
Over a decade, three patients with systemic capillary leak syndrome presented at our institution. All three patients were treated with terbutaline and aminophylline. Prednisone was used during the course of treatment in each of the three patients.


RESULTS
In contrast to previous reports of partial or temporary control of episodes, all three patients are alive with almost complete resolution of their recurrent attacks and have been able to return to their normal lifestyles.


CONCLUSIONS
The regimen of terbutaline and aminophylline effectively prevents the attacks of hypotension and hemoconcentration that occur in systemic capillary leak syndrome. The role of prednisone is not clear. Until more is known about the pathophysiology of the disorder, treatment must remain empiric and supportive.
Droder
R M
RM
Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Kyle
R A
RA
Greipp
P R
PR
D000368:Aged; D000628:Aminophylline / Q000008:administration & dosage / Q000627:therapeutic use*; D001810:Blood Volume / Q000187:drug effects; D002199:Capillary Permeability / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D013577:Syndrome; D013726:Terbutaline / Q000008:administration & dosage / Q000627:therapeutic use*
D000628:Aminophylline; D011239:Prednisolone; D013726:Terbutaline