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Interleukin-11-induced capillary leak syndrome in primary hepatic carcinoma patients with thrombocytopenia.

Kai-Feng W, Hong-Ming P, Hai-Zhou L, Li-Rong S, Xi-Yan Z - BMC Cancer (2011)

Bottom Line: Capillary leak syndrome (CLS) is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with hypoproteinemia.The detection of IL-11-induced CLS supports the hypothesis that CLS could be a severe side effect of IL-11 treatment in some patients.In addition, bleeding after RFA might be a further inducer of CLS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China.

ABSTRACT

Background: Capillary leak syndrome (CLS) is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with hypoproteinemia. Interleukin-11 (IL-11) is a promising therapeutic agent for thrombocytopenia. A direct correlation between IL-11 and CLS has never been reported previously, particularly in patients with hepatic carcinoma.

Case presentation: We describe two cases of CLS after IL-11 administration in two males with thrombocytopenia. Case 1 was a 46-year-old man with recurrence of hepatic carcinoma who was treated with IL-11 (3 mg per day). After four days of therapy, hypotension and hypoproteinemia were detected. The chest X-ray and B ultrasound of the abdomen showed pleural effusion and ascites. IL-11 was then discontinued, fluid resuscitation was performed, and fresh frozen plasma and packed red blood cells were transfused into this patient. The patient had recovered after 19 days of treatment. Case 2 was a 66-year-old man who had undergone radiofrequency ablation (RFA) for hepatic carcinoma. He was treated with IL-11 (3 mg per day) for thrombocytopenia. After two days of therapy, this patient complained of dyspnea with bilateral edema of the hands. Laboratory values showed hypoproteinemia. IL-11 was stopped and human albumin was transfused at a rate of 10 g per day. On the 4th day, fluid resuscitation was performed. The patient had recovered after treatment for two weeks.

Conclusions: The detection of IL-11-induced CLS supports the hypothesis that CLS could be a severe side effect of IL-11 treatment in some patients. These two case reports also demonstrate that patients with hepatic carcinoma who experience this rare form of CLS after treatment with IL-11 seem to respond to a therapeutic regimen that involves hydroxyethyl starch, albumin, and diuretic therapy. Liver cancer patients might be more susceptible to CLS because of poor liver function and hypersplenia. In addition, bleeding after RFA might be a further inducer of CLS.

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The right diaphragm and costophrenic angle were obscured. There was moderate right pleural effusion in case 1 after treatment with IL-11.
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Figure 1: The right diaphragm and costophrenic angle were obscured. There was moderate right pleural effusion in case 1 after treatment with IL-11.

Mentions: Four days later, the patient felt fullness of the abdomen. His oral body temperature was 39.8°C, blood pressure was 102/61 mmHg, and pulse was 118 bpm. The breath sounds of the lower right lung were weak. Shifting dullness was detected in the abdomen. Laboratory values were as follows: leukocytes count 4.2 × 109/L; hemoglobin 11.7 g/dL; hematocrit 34%; platelet count 46 × 109/L. Piperacillin/Tazobactam was infused at a dose of 4.5 g q8 h for prophylaxis against infection. Indomethacin was administered against fever. However, the hypotension did not improve. At 21:00 on the same day, the patient complained of dyspnea and fatigue, his blood pressure was 86/52 mmHg, pulse was 120 bpm, and temperature was 40.5°C. The X-ray of his chest is shown in Figure 1. There were moderate amounts of ascites in the abdomen as shown by B ultrasound (Figure 2). As a consequence, fluid infusion was administered rapidly to this patient. However, the edema deteriorated dramatically and he developed oliguria, but pulmonary edema was not observed. The patient was transferred to the ICU department at 23:00, when his blood pressure was 76/49 mmHg, and pulse was 122 bpm. Fluid resuscitation and the administration of dopamine were initiated. On ICU day 2, the laboratory values were as follows: leukocytes count 7.0 × 109/L; hemoglobin 7.5 g/dL; hematocrit 21.7%; platelet count 30 × 109/L. Serum albumin had decreased to 1.8 g/dL. Therefore, packed red blood cells (pRBCs) 4.0 units with fresh frozen plasma (FFP) 400 ml were transfused into this patient at 02:00 and infusion of hydroxyethyl starch and albumin was started. On ICU day 3, serum albumin had increased to 2.3 g/dL. Over the following days, the hypovolemic shock and pleural effusion subsided gradually. However, on ICU day 4, edema of feet, the penis and scrotum appeared (Figure 3), and the patient was treated with albumin (10 g per day), spironolactone (40 mg per day), and hydrochlorothiazide (25 mg per day). The edema was alleviated gradually. After 19 days of treatment, the patient was discharged. On the day of discharge, the laboratory values were as follows: leukocytes count 5.2 × 109/L; hemoglobin 11.3 g/dL; hematocrit 33.3%; platelet count 65 × 109/L. Serum albumin had increased to 3.1 g/dL.


Interleukin-11-induced capillary leak syndrome in primary hepatic carcinoma patients with thrombocytopenia.

Kai-Feng W, Hong-Ming P, Hai-Zhou L, Li-Rong S, Xi-Yan Z - BMC Cancer (2011)

The right diaphragm and costophrenic angle were obscured. There was moderate right pleural effusion in case 1 after treatment with IL-11.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3118946&req=5

Figure 1: The right diaphragm and costophrenic angle were obscured. There was moderate right pleural effusion in case 1 after treatment with IL-11.
Mentions: Four days later, the patient felt fullness of the abdomen. His oral body temperature was 39.8°C, blood pressure was 102/61 mmHg, and pulse was 118 bpm. The breath sounds of the lower right lung were weak. Shifting dullness was detected in the abdomen. Laboratory values were as follows: leukocytes count 4.2 × 109/L; hemoglobin 11.7 g/dL; hematocrit 34%; platelet count 46 × 109/L. Piperacillin/Tazobactam was infused at a dose of 4.5 g q8 h for prophylaxis against infection. Indomethacin was administered against fever. However, the hypotension did not improve. At 21:00 on the same day, the patient complained of dyspnea and fatigue, his blood pressure was 86/52 mmHg, pulse was 120 bpm, and temperature was 40.5°C. The X-ray of his chest is shown in Figure 1. There were moderate amounts of ascites in the abdomen as shown by B ultrasound (Figure 2). As a consequence, fluid infusion was administered rapidly to this patient. However, the edema deteriorated dramatically and he developed oliguria, but pulmonary edema was not observed. The patient was transferred to the ICU department at 23:00, when his blood pressure was 76/49 mmHg, and pulse was 122 bpm. Fluid resuscitation and the administration of dopamine were initiated. On ICU day 2, the laboratory values were as follows: leukocytes count 7.0 × 109/L; hemoglobin 7.5 g/dL; hematocrit 21.7%; platelet count 30 × 109/L. Serum albumin had decreased to 1.8 g/dL. Therefore, packed red blood cells (pRBCs) 4.0 units with fresh frozen plasma (FFP) 400 ml were transfused into this patient at 02:00 and infusion of hydroxyethyl starch and albumin was started. On ICU day 3, serum albumin had increased to 2.3 g/dL. Over the following days, the hypovolemic shock and pleural effusion subsided gradually. However, on ICU day 4, edema of feet, the penis and scrotum appeared (Figure 3), and the patient was treated with albumin (10 g per day), spironolactone (40 mg per day), and hydrochlorothiazide (25 mg per day). The edema was alleviated gradually. After 19 days of treatment, the patient was discharged. On the day of discharge, the laboratory values were as follows: leukocytes count 5.2 × 109/L; hemoglobin 11.3 g/dL; hematocrit 33.3%; platelet count 65 × 109/L. Serum albumin had increased to 3.1 g/dL.

Bottom Line: Capillary leak syndrome (CLS) is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with hypoproteinemia.The detection of IL-11-induced CLS supports the hypothesis that CLS could be a severe side effect of IL-11 treatment in some patients.In addition, bleeding after RFA might be a further inducer of CLS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Oncology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, China.

ABSTRACT

Background: Capillary leak syndrome (CLS) is a rare condition characterized by recurrent episodes of generalized edema and severe hypotension associated with hypoproteinemia. Interleukin-11 (IL-11) is a promising therapeutic agent for thrombocytopenia. A direct correlation between IL-11 and CLS has never been reported previously, particularly in patients with hepatic carcinoma.

Case presentation: We describe two cases of CLS after IL-11 administration in two males with thrombocytopenia. Case 1 was a 46-year-old man with recurrence of hepatic carcinoma who was treated with IL-11 (3 mg per day). After four days of therapy, hypotension and hypoproteinemia were detected. The chest X-ray and B ultrasound of the abdomen showed pleural effusion and ascites. IL-11 was then discontinued, fluid resuscitation was performed, and fresh frozen plasma and packed red blood cells were transfused into this patient. The patient had recovered after 19 days of treatment. Case 2 was a 66-year-old man who had undergone radiofrequency ablation (RFA) for hepatic carcinoma. He was treated with IL-11 (3 mg per day) for thrombocytopenia. After two days of therapy, this patient complained of dyspnea with bilateral edema of the hands. Laboratory values showed hypoproteinemia. IL-11 was stopped and human albumin was transfused at a rate of 10 g per day. On the 4th day, fluid resuscitation was performed. The patient had recovered after treatment for two weeks.

Conclusions: The detection of IL-11-induced CLS supports the hypothesis that CLS could be a severe side effect of IL-11 treatment in some patients. These two case reports also demonstrate that patients with hepatic carcinoma who experience this rare form of CLS after treatment with IL-11 seem to respond to a therapeutic regimen that involves hydroxyethyl starch, albumin, and diuretic therapy. Liver cancer patients might be more susceptible to CLS because of poor liver function and hypersplenia. In addition, bleeding after RFA might be a further inducer of CLS.

Show MeSH
Related in: MedlinePlus