title: Systemic capillary leak syndrome presenting as recurrent shock.
abstract: OBJECTIVE
  To report a case of systemic capillary leak syndrome (SCLS) in a child.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Pediatric intensive care unit.
  
  
  METHODS
  A 6-yr-old girl was admitted twice to the pediatric intensive care unit, at a 10-month interval, in severe shock with important edema.
  
  
  RESULTS
  The patient presented with acute symptoms of abdominal pain, vomiting, and syncope in the hour preceding the shock. During both episodes necessary management included aggressive intravenous fluid rehydration, mechanical ventilation, and use of inotropes/vasopressors. Suspicion of a lower limb fasciitis necessitated surgical exploration, but pathology reports were negative on both occasions revealing only subcutaneous tissue edema. The patient recovered within 24 hrs on both episodes. Investigation ruled out cardiogenic shock and septic shock due to bacterial etiology. On the first episode, a nasopharyngeal aspirate was positive for influenza A (H3N2) by both viral immunofluorescence and culture. The presumed diagnosis was toxic shock syndrome associated with influenza virus. On the second episode, all bacterial and virology cultures remained negative. Hypovolemic shock was suspected, but there was no history of dehydration, bleeding, or gastrointestinal losses (persistent vomiting or diarrhea). Noninfectious causes of hypovolemic shock with edema were ruled out, leading us to believe that she suffered from SCLS.
  
  
  CONCLUSIONS
  Although well described in the adult literature, there have been few reports of SCLS in pediatric patients. SCLS should be considered in the differential diagnosis of recurrent hypovolemic shock without identifiable cause. The only therapeutic intervention is to obtain vascular access when initial manifestations occur and give aggressive fluid reanimation.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.
authors.forename: Christos
authors.initials: C
authors.lastname: Karatzios
authors.forename: France
authors.initials: F
authors.lastname: Gauvin
authors.forename: E Patricia
authors.initials: EP
authors.lastname: Egerszegi
authors.forename: Bruce
authors.initials: B
authors.lastname: Tapiero
authors.forename: Chantal
authors.initials: C
authors.lastname: Buteau
authors.forename: Georges Etienne
authors.initials: GE
authors.lastname: Rivard
authors.forename: Philippe
authors.initials: P
authors.lastname: Ovetchkine
mesh_terms: D019559:Capillary Leak Syndrome / Q000150:complications / Q000175:diagnosis*; D002648:Child; D004487:Edema / Q000209:etiology*; D005260:Female; D006801:Humans; D053121:Influenza A Virus, H2N2 Subtype; D007251:Influenza, Human / Q000150:complications; D012008:Recurrence; D012769:Shock / Q000209:etiology*