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Capillary leak syndrome: case report A 32-year-old man developed capillary leak syndrome (CLS) during treatment with chemoprotectant pegfilgrastim to support neutrophil recovery and rituximab for mediastinal lymphoma [routes, dosages and duration of treatments to reaction onset not stated]. The man had been receiving EPOCH-R regimen comprising rituximab infusion on day 1, followed by prednisone, continuous infusion of etoposide, vincristine and doxorubicin, and short infusion of cyclophosphamide on day 5. Additionally, he received pegfilgrastim [Neulasta; pegylated neupogen] for neutrophil recovery. The first cycle was well-tolerated. After the second cycle, he experienced dyspnoea, which worsened during activity. A diagnosis of pegfilgrastim-induced CLS was suspected. Therefore, it was decided to stop pegfilgrastim during further cycles. On day 4 of the third cycle, the man was hospitalised with sudden onset dyspnoea. On admission, vital signs showed tachycardia, tachypnoea and hypotension. Laboratory investigations revealed leukocytosis, thrombocytosis, hypoalbuminaemia, elevated levels of haematocrit, procalcitonin, lactic acid hypoalbuminaemia and exudative pleural effusion. A chest x-ray showed diffuse interstitial infiltrate. A CT scan showed diffuse interstitial infiltrate. An ECG demonstrated preserved systolic function and no pericardial effusion. He was treated with vancomycin, meropenem and fluid bolus for a misdiagnosis of sepsis. However, his respiratory condition continued to worsen. Repeat CT-scan findings confirmed the diagnosis of CLS. He was therefore shifted to the ICU, and was intubated. He received unspecified vasopressive therapy. After complete recovery, he was weaned off vasopressive therapy, extubated on day 2, and was shifted to the general unit. Thereafter, he developed ventilator-associated pneumonia with Staphylococcus epidermidis growth, and continued to receive vancomycin and meropenem. During follow-up visit, a positron emission tomography/CT scan showed complete resolution of aforementioned abnormalities, and remission of lymphoma. He completed remaining 3 cycles of chemotherapy (CHOP regimen excluding rituximab) without any further adverse event. Vedala K, et al. Capillary Leak Syndrome From Rituximab Therapy of Lymphoma. Journal of Investigative Medicine High Impact Case Reports 8: 1 Jan 2020. Available 803499401 from: URL: http://doi.org/10.1177/2324709620942372

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