{"doi":"10.7326/l21-0250","title":"Severe Exacerbations of Systemic Capillary Leak Syndrome After COVID-19 Vaccination: A Case Series","abstract":"Letters15 June 2021Severe Exacerbations of Systemic Capillary Leak Syndrome After COVID-19 Vaccination: A Case SeriesFREEMeghan Matheny, BS, Noble Maleque, MD, Natalie Channell, MD, A. Robin Eisch, RN, MS, Sara C. Auld, MD, Aleena Banerji, MD, Kirk M. Druey, MDMeghan Matheny, BSNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MarylandSearch for more papers by this author, Noble Maleque, MDEmory University School of Medicine and Rollins School of Public Health, Atlanta, GeorgiaSearch for more papers by this author, Natalie Channell, MDMaine Medical Center, Portland, MaineSearch for more papers by this author, A. Robin Eisch, RN, MSNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MarylandSearch for more papers by this author, Sara C. Auld, MDEmory University School of Medicine and Rollins School of Public Health, Atlanta, GeorgiaSearch for more papers by this author, Aleena Banerji, MDMassachusetts General Hospital and Harvard Medical School, Boston, MassachusettsSearch for more papers by this author, Kirk M. Druey, MDNational Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MarylandSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0250 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Flares of systemic capillary leak syndrome (SCLS) release plasma into peripheral tissues, which typically leads to hypotensive shock and multiple organ dysfunction (1). Anasarca and compartment syndromes may develop as a result of excessive intravenous (IV) fluid administration (2). Between episodes, patients are typically asymptomatic. The diagnosis of SCLS is based on characteristic clinical findings that include hypotension, hemoconcentration, and hypoalbuminemia. Prophylaxis with IV immunoglobulin (IVIG) is disease sparing and improves survival (3).We describe 3 patients who had severe flares of SCLS immediately after receiving standard doses of the COVID-19 vaccines that have emergency use authorization from the U.S. Food and Drug Administration. These events were classified as non–dose-related, unexpected, and serious adverse events according to the World Health Organization.Objective: To alert clinicians to the possibility of SCLS-like events immediately after COVID-19 vaccination.Case Reports: Patient demographic characteristics and hospital experiences are detailed in Table 1, and the results of selected laboratory tests are summarized in Table 2.Table 1 Patient Demographic Characteristics and Hospital ExperiencesTable 2 Laboratory AbnormalitiesPatient 1 was diagnosed with SCLS with monoclonal gammopathy of unknown significance in 2006 after 2 characteristic episodes. She declined IVIG treatment but had no disease relapses during 15 years of treatment with oral theophylline and terbutaline. In March 2021, she presented to the emergency department of Exeter Hospital 2 days after receiving a single dose of the Ad26.COV2.S vaccine (Janssen). She had hypotension and tachycardia and developed protracted shock and anasarca. Results of blood cultures and nasal swab polymerase chain reaction tests for SARS-CoV-2 were negative. After she developed additional SCLS-related complications and continued to deteriorate, care was discontinued on hospital day 7.Patient 2 had a normal vaginal delivery in 2002 followed by hypotension and edema, which was attributed to amniotic fluid embolism. In 2018, she had another episode of hypotension (systolic blood pressure was approximately 50 mm Hg) and anasarca after several days of upper respiratory symptoms. This episode was attributed to sepsis, although blood culture results were negative. In February 2021, she presented to the emergency department of Virginia Hospital Center 2 days after receiving the second dose of the mRNA","journal":"Annals of Internal Medicine","year":2021,"id":164244,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9563,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":685125,"name":"Noble Maleque","orcid":"0000-0002-9829-4662","position":1,"is_corresponding":false},{"id":685882,"name":"Natalie Channell","orcid":null,"position":2,"is_corresponding":false},{"id":518298,"name":"A. Robin Eisch","orcid":null,"position":3,"is_corresponding":false},{"id":433638,"name":"Sara C. Auld","orcid":"0000-0002-8972-3736","position":4,"is_corresponding":false},{"id":227958,"name":"Aleena Banerji","orcid":"0000-0001-9569-9915","position":5,"is_corresponding":false},{"id":369508,"name":"Kirk M. Druey","orcid":"0000-0002-5834-6501","position":6,"is_corresponding":false},{"id":685124,"name":"Meghan Matheny","orcid":"0000-0003-3981-520X","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-18T23:45:27.031465Z","pmid":"34125573","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}