Unusual cause of capillary leak syndrome with shock in a child

CASE REPORTS

Unusual cause of Capillary leak syndrome with shock in a child

Poovazhagi Varadarajan¹, Gomathy Srividya Venugopal¹, Ramesh Subramaniyan¹, Nisha Rangabashyam¹, Balaraman Velayutham².

¹Department of Pediatric Intensive Care, Institute of Child Health and Hospital for children, Chennai,
²Department of pediatric Nephrology, Institute of Child Health and Hospital for children, Chennai.

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Abstract
A 12 years male child with lethargy, vomiting, and pain abdomen presented with compensated shock at our emergency department. Shock managed with 2 boluses of normal saline and started on inotropes. Ejection fraction was 35%. Child was intubated and shifted to pediatric intensive care unit. Initial diagnosis was septic shock/dengue shock syndrome/Multisystem inflammatory syndrome associated with Covid 19 (MIS- C). Child showed chemosis, parotitis, edema of eyelids, hemoconcentration, bilateral pleural fluid, ascites, hypoalbuminemia, and progressed to multiorgan failure. On examination, two fang marks were noted near the gluteal fold. Capillary leak syndrome with shock following snake envenomation was thought of Child received 30 vials of ASV with supportive management. Developed acute kidney injury and coagulopathy and was started on hemodialysis. Child received IV immunoglobulin. Despite the efforts, child died on the fourth day of hospitalization.

Why this article important?

1. this sort of presentation is so rare and we wanted the information to be disseminated to the pediatricians. this will reach the pediatricians of the country. this is an uncommon presentation and unless recognised in time mortality is very high .this is the first time our Institute had seen such a complication in a child with snake envenomation and despite best of efforts the outcome is not good.Literature revealed no specific management and the treatment is supportive. though reported from kerala and tamil Nadu very few reports exist about this capillary leak in snake envenomation This is an unusual cause of capillary leak and is difficult to identify in the absence of a definite snake bite history.

Summary of article

unusual presentation in snake envenomation we had encountered in our PICU and we wanted to share this in your esteemed journal .this is an uncommon presentation and unless recognised in time mortality is very high .this is the first time our Institute had seen such a complication in a child with snake envenomation and despite best of efforts the outcome is not good.Literature revealed no specific management and the treatment is supportive. though reported from kerala and Tamil Nadu very few reports exist about this capillary leak in snake envenomation . Capillary leak is a common scenario in sick children in PICU and sepsis and cytokine storm account for majority of the etiology .This is an unusual cause of capillary leak and is difficult to identify in the absence of a definite snake bite history.

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