Capillary Leak Syndrome Aggravated by Influenza Type A Infection

A 41-year-old female presented to the emergency department with nausea, vomiting, and diarrhea. Five days prior to this, she tested positive for influenza type A in an urgent care clinic and received Tamiflu. She also complained of generalized weakness in her extremities. Her initial labs were concerning for a grossly elevated hemoglobin and hematocrit despite adequate fluid resuscitation. Her condition continued to worsen as she developed distal cyanosis in all of her extremities and pulselessness. She was treated with IV hydration, bicarbonate, heparin, vasopressors, albumin replacement, Tamiflu, and phlebotomy. Her blood pressure continued to deteriorate rapidly. The arterial blood gas (ABG) depicted a case of severe metabolic acidosis that ultimately resulted in respiratory failure, and she required mechanical ventilation within 24 hours. Systemic capillary leak syndrome is a rare disease that is characterized by hypotension, hemoconcentration, and hypoalbuminemia. In this instance, influenza type A played a large role in its development.