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Sorafenib-Induced Capillary Leak Syndrome
Hyunwoo Kwon1, John Odackal2, Marium Husain3
1Physician Scientist Training Program, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Case Reports in Oncology
|October 30, 2023
Summary
Sorafenib can cause capillary leak syndrome, a rare condition of endothelial hyperpermeability. This case highlights an atypical presentation without hypotension, emphasizing the need for vigilance in cancer patients.
Area of Science:
- Oncology
- Pharmacology
- Critical Care Medicine
Background:
- Capillary leak syndrome (CLS) is a rare, life-threatening disorder characterized by acute endothelial hyperpermeability.
- Drug-induced CLS is a critical diagnostic consideration in cancer patients, especially those treated with targeted therapies.
- Sorafenib, a multi-kinase inhibitor, has not been previously associated with CLS.
Observation:
- A 29-year-old female with a desmoid tumor developed acute hypoxic respiratory failure shortly after initiating sorafenib therapy.
- The patient presented with extensive pulmonary edema, bilateral pleural effusions, and hemoconcentration.
- Diagnostic work-up for infectious and cardiac etiologies was negative.
Findings:
- The clinical presentation and temporal association with sorafenib initiation strongly suggested sorafenib-induced CLS.
- This case represents an atypical presentation of CLS, notably without preceding or concurrent hypotension.
- Supportive care, including noninvasive mechanical ventilation and diuresis, led to stabilization of the patient's condition.
Implications:
- This report expands the known adverse effects of sorafenib to include CLS.
- It underscores the importance of considering drug-induced CLS in cancer patients presenting with unexplained edema and respiratory distress, even in the absence of hypotension.
- Early recognition and supportive management are crucial for favorable outcomes in sorafenib-induced CLS.
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