Rapid Progression of COVID-19-Associated Fatal Capillary Leak Syndrome

Several cases of capillary leak syndrome (CLS) related to COVID-19 or vaccination against SARS-CoV-2 have been described in the literature. We present a case of a 42-year-old, previously healthy male, presenting with a mild form of COVID-19, who suddenly developed severe shock with hypotension and severe hemoconcentration within hours of admission to the hospital. Volume resuscitation was not effective, increasing hemoglobin (198 g/L on admission, 222 g/L 9 h later) suggested fluid leak into peripheral tissues. After cardiac arrest, the patient was resuscitated and connected to extracorporeal membrane oxygenation, but died shortly afterwards due to refractory heart failure. Retrospective investigation of blood samples confirmed diagnosis of CLS by progressive hypoalbuminemia (40 g/L on admission, 14 g/L 19 h later) and monoclonal gammopathy kappa (4.7 g/L). Patient's CLS was triggered by COVID-19, either a first attack of idiopathic CLS called Clarkson's disease or a COVID-19-induced secondary CLS.