Bilateral compartment syndrome secondary to systemic capillary leak syndrome. A case report
DOI:
https://doi.org/10.58814/01208845.511Keywords:
Anterior Compartment Syndrome, Fasciotomy, Systemic Capillary Leak SyndromeAbstract
Introduction: Systemic capillary leak syndrome (SCLS) is a rare life-threatening disorder of uncertain ethology characterized by increased vascular permeability, resulting in fluid leakage into the interstitial space. Compartment syndrome is a rare complication of increased interstitial volume due to SCLS.
Case presentation: A 34-year-old man presented to the emergency department of a hospital in Segovia (Spain) with myalgia and paresthesias in the lower limbs with no apparent cause. Given the worsening of symptoms despite the use of anesthetics, the increase in volume in the anterior and lateral compartments of the left leg on physical examination, and the elevated hematocrit (54.1%) and creatine phosphokinase (CPK; 700U/L) levels for no obvious reason three hours after admission, he was diagnosed with compartment syndrome in both legs. Consequently, he was taken immediately to surgery (fasciotomies of the anterior and lateral compartments). Although the intensity of pain and paresthesias decreased after the procedure, the patient reported feeling the same symptoms in the right arm, being admitted to the intensive care unit 9 hours later and requiring ventilation due to suspicion of distributive shock. Two days after the first intervention, the intracompartmental pressure of the right arm was measured, confirming compartment syndrome, which prompted a new fasciotomy, achieving a progressive improvement in the patient's clinical condition to the point of being transferred to the general hospital ward without fluid therapy. Based on a new anamnesis and once other etiologies were ruled out, he was diagnosed with SCLS following type A influenza and was discharged 22 days after his admission. During follow-up, the patient did not experience prodromes or symptomatology associated with a new episode of SCLS, but he did experience decreased left hallux extension strength as a consequence of compartment syndrome.
Conclusion: Continuous monitoring of compartment pressure after fluid resuscitation in patients with SCLS could contribute to the early detection of possible compartment syndrome.
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