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Twenty-four hours later, she was admitted to the intensive care unit because of severe hypotension, requiring norepinephrine up to 0.5 μg/kg/min, hypoalbuminemia, and hemoconcentration. She was diagnosed with systemic capillary leak syndrome (SCLS) with intramyocardial edema (IME). SCLS is a condition characterized by the leakage of plasma and proteins into the interstitial compartment. It is associated with monoclonal gammopathy, and often occurs after an upper respiratory tract infection, with IME being a rare complication in this disease. In our patient, the transthoracic echocardiogram (TTE) performed at admission revealed that left ventricle ejection fraction (LVEF) was at the lower normal limit (LVEF 50%-55%) with restrictive physiology and evidence of diffuse myocardial thickening, as shown in the TTE images: parasternal long-axis view (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and Video A), parasternal short-axis view at apical level (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), and apical four-chamber view (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). This thickering was likely due to IME, since a TTE performed 1 month earlier showed normal myocardial thickness (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>, parasternal long-axis view). Treatment with immunoglobulins and corticosteroids was prescribed, but unfortunately, the patient died 24 hours after admission due to refractory shock.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0010" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez Gómez M, Calle Romero M, Domingo Marín S. 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Med Intensiva. 2024. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.medin.2024.05.009">https://doi.org/10.1016/j.medin.2024.05.009</span></p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0020" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 742 "Ancho" => 992 "Tamanyo" => 76034 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 742 "Ancho" => 992 "Tamanyo" => 70967 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 742 "Ancho" => 992 "Tamanyo" => 68493 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 741 "Ancho" => 997 "Tamanyo" => 83506 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] ] 4 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 1539992 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/unassign/S2173572724001620/v1_202406280418/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/unassign/S2173572724001620/v1_202406280418/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724001620?idApp=WMIE" ]
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Images in Intensive Medicine
Available online 28 June 2024
Intramyocardial edema as an atypical manifestation of capillary leak syndrome
Edema intramiocárdico como manifestación atípica del síndrome de fuga capilar
Montserrat Rodríguez Gómez
, María Calle Romero, Sara Domingo Marín
Corresponding author
Hospital Clínico San Carlos, Madrid, Spain