Capillary Leak Syndrome Associated with Anaplastic T Cell Lymphoma and Transcutaneous Exudation: an Unusual Presentation

Capillary leak syndrome is a rare complication of cancer, particularly of hematologic malignancies. The syndrome was first described as an idiopathic entity; however, increasingly, more cases are being reported in association with cancers and other conditions. Diagnosis stems from the recognition of the double paradox, consisting of severe generalized oedema and hypotension, accompanied by hallmark laboratory modifications. Concurrent conditions in patients with malignancies can alter laboratory findings and make the diagnosis a challenge. This report presents the case of a patient with capillary leak syndrome and an atypical presentation, with generalized skin rash and transcutaneous exudation occurring concurrently with anaplastic large T cell lymphoma, macrophage activation syndrome, and cytopenias. Symptom-specific treatment with diuretics and albumin was ineffective in the case of our patient; however, the CLS remitted promptly with cancer-specific therapy. No treatment has proved to be generally effective against CLS up to date, as is the case for this patient. Thus, the rapid recognition of cancer-associated capillary leak syndrome and the initiation of cancer-specific treatment proves to be the better approach and is key to avoiding unnecessary delays and ineffective treatments targeted specifically at CLS.