Gemcitabine-induced systemic capillary leak syndrome

Systemic capillary leak syndrome (SCLS) is a rare disorder with ahigh mortality rate, characterized by rapidly developing edema, weightgain and hypotension, hemoconcentration and hypoproteinemia. Thissyndrome is caused by sudden, reversible capillary hyperpermeabilitywith a rapid extravasation of plasma from the intravascular to theinterstitial space. Even though SCLS has been suggested to be thepathogenic mechanism for the pulmonary toxicity of gemcitabine (GCB), anew deoxycytidine analogue with structural similarities to cytosinearabinoside, a direct correlation between GCB and SCLS has never beenreported. We describe a case of repeated SCLS after GCB administrationin a 51-year-old male with locally-advanced non-small-cell lung cancertreated with a combination of cisplatin and GCB. The detection ofGCB-induced SCLS supports the hypothesis that SCLS could be thepathogenic way of GCB pulmonary toxicity. This finding can help tobetter understand and treat the potentially deadly GCB-related acuterespiratory distress syndrome that is being recognized.