title: Systemic capillary leak syndrome: is methylene blue the silver bullet?
abstract: Background. Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by unexplained, recurrent episodes of transient, abrupt increase in endothelial permeability, leading to severe hypotension, generalized edema, and hemoconcentration. Case Report. We report the case of a patient suffering from systemic capillary leak syndrome and present a possible interpretation of the pathophysiology of this condition. Besides the classical triad of hypotension, edema, and hemoconcentration, we recorded increased levels of methemoglobin, an index of NO overproduction. We present a possible interpretation of the pathophysiology of this condition based on the fast and complete reversal of symptoms after methylene blue administration (which opposes NO-induced effects) and speculate that increased NO levels could be implicated in the pathophysiology of the capillary leak phase. Why should an emergency physician be aware of this? The safety of this treatment and its fluid- and cathecolamine-sparing effect deserve consideration and further research.
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo Universitario, Via A. Di Rudinì 8, 20142 Milano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Umbrello
authors.affiliation: Unità Operativa di Medicina IV, Azienda Ospedaliera San Paolo, Polo Universitario, Via A. Di Rudinì 8, 20142 Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gardinali
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo Universitario, Via A. Di Rudinì 8, 20142 Milano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ottolina
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo Universitario, Via A. Di Rudinì 8, 20142 Milano, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Zanforlin
authors.affiliation: Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliera San Paolo, Polo Universitario, Via A. Di Rudinì 8, 20142 Milano, Italy ; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Via F. Sforza 35, 20122 Milano, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Iapichino